CHOLESTEROL FROM EGGS NOT ASSOCIATED WITH HEART DISEASE RISK

Cholesterol is a waxy substance produced by the body which uses it to create hormones, produce bile acids for digestion, make vitamin D and maintain healthy cell walls.  In the diet, it is found in fish, chicken, meat, eggs, and dairy foods.  Advice to limit dietary cholesterol dates back 50 years but over the last 10 years recommendations have been gradually changing and now neither the Dietary Guidelines for Americans nor the American Heart Association set limitations on cholesterol intake.  It is still thought that a small percentage of persons with genes that predispose them to increased blood cholesterol will see blood cholesterol levels significantly increased by dietary intake.  However, a recent study that included a large percentage of carriers of a gene called apolipoprotein E type 4 (Apoe4) which significantly impacts cholesterol metabolism and puts carriers at higher risk for heart disease, found that even in this group heart health appeared unrelated to dietary cholesterol intake.

In this study researchers tracked for 21-years the dietary habits and heart health of 1,032 middle-aged Finnish men, one-third of which had the Apoe4 gene.  All were heart healthy at the study's start but by the end of the tracking period over 20% had experienced at least one heart attack.  Participants averaged about 400mg of daily cholesterol intake with an average intake of one egg per day.  Among the study sample as a whole as well as among Apoe E carries, the results revealed no association between egg intake or overall cholesterol intake and heart attack.  They also found no association between cholesterol intake and carotid artery thickness, a marker of ischaemic heart disease and stroke risk.

One of the reasons that cholesterol intake had been thought to be linked to heart disease is that many foods that are rich in cholesterol are also rich in unhealthy saturated fats and intake of saturated fats does significantly impact blood cholesterol and heart health.  For example, fatty meats, chicken skin, and creamy dairy are all high in both.  But, some foods such as egg yolks, shellfish, and liver are low in saturated fat but high in cholesterol.  Moderate intake of these foods does not appear to damage heart health in most individuals.  Still, researchers caution it is still unknown whether very high intake of cholesterol such as an average of three eggs daily negatively impacts heart health. There is also some data suggesting diabetics may be vulnerable to negative cardiovascular effects of high dietary cholesterol intake.

     

What to do:  When making changes to your diet, always discuss what is right for you with your care provider, but the research appears to indicate that for most individuals intake averaging about 1 egg per day is healthy.  Eggs are nutritional powerhouses -- good sources of protein, essential fats, iron, B vitamins, vitamin D, and anti-oxidants lutein, zeaxanthin.  To control blood cholesterol, recommendations to limit saturated (the fats found in meat, chicken skin, and dairy) and completely avoid trans fats (artificial fats used to manufacture baked goods, frosting, and spreads) are still in place.  Also, high intake of sugar and refined flours is emerging as another important driver of heart disease risk.  So, to control blood cholesterol avoid trans fats and limit saturated fats, sugar, and refined carbohydrates.  Instead, eat a healthy diet rich in plant-derived fats (i.e. olive oil, nuts, avocado), fruits and vegetables, whole grains, and lean proteins.    Emphasize foods high in soluble fiber such as beans, oats, barley, and gummier fruits and vegetables including avocado, okra, plums, apples, oranges, green beans, and carrots.  Control your weight, exercise regularly, and take cholesterol lowering medicine as prescribed by your provider.

Sources:

Berger S, Raman G, Vishwanathan R et al.  Dietary cholesterol and cardiovascular disease: A systematic review and meta-analysis.  American Journal of Clinical Nutrition.  2015; 102: 276-294.  First published online June 24, 2015. DOI:10.3945/ajcn.114.100305

Eckel, RH.  Eggs and beyond: is dietary cholesterol no longer important?  American Journal of Clinical Nutrition.  2015; 102: 2 235-236; First published online July 15, 2015.  DOI:10.3945/ajcn.115.116905

Virtanen J, Mursu J, Virtanen H, et al. Associations of egg and cholesterol intakes with carotid intima-media thickness and risk of incident coronary artery disease according to apolipoprotein E phenotype in men: The Kuopio Ischaemic Heart Disease Risk Factor Study. American Journal of Clinical Nutrition, 2016. DOI:10.3945/ajcn.115.122317

Adapted from articles available at:

http://www.medicaldaily.com/cholesterol-eggs-heart-health-374040

https://www.nlm.nih.gov/medlineplus/news/fullstory_157281.html

https://www.sciencedaily.com/releases/2016/02/160211083044.htm

RESTAURANT ENTREES AVERAGE OVER 1200 CALORIES!

Meals consumed at fast-food restaurants are often perceived as one of the biggest contributors to the obesity epidemic. Non-chain restaurants are often seen as the healthier choice.  However, a new study measured the caloric content of entrees from sit-down and take-out chain and non-chain restaurants and found no significant difference in the calories of entrees at chain and non-chain restaurants.  Both averaged around 1200 calories!  This does not include the beverages, appetizers, and desserts that often are includes at a meal out.    Fully 92% of the entrees exceeded recommended calorie intake for a single meal and a significant number had more calories than are advised for an entire day’s worth of intake.  Considering Americans average six meals prepared outside of the home weekly, restaurant meals are a sizable part of our diets.

The study was based on an analysis of 364 of the most popular entrees at American, Chinese, Greek, Indian, Italian, Japanese, Mexican, Thai and Vietnamese restaurants in Boston, San Francisco and Little Rock, Ark., between 2011 and 2014.  In each area, they included about a dozen restaurants across a range of cuisines, from American burger joints to Italian trattorias and Greek cafes. There were no significant differences in calorie counts between cities but some cuisines significantly differed in calories.  Overall entrees averaged 1200 calories, but American, Chinese, Indian and Italian cuisines averaged even higher with nearly 1500 calories per entree. 

What is the recommended limit for intake at a meal?  Estimates are based on a person's gender, age and how physically active they are.  For example, for weight maintenance, a moderately active (defined as doing at least 150 minutes per week of moderate intensity activity such as brisk walking) woman aged 19-30, is recommended to have around 2,000 calories daily and 570 calories per meal, while a moderately active man of the same age is recommended to have around 2,600 calories daily and around 740 calories per meal.  The calorie needs of persons who are older, less active, and/or of small stature need less.  Even when age, gender, height, and activity are factored in, calorie needs vary tremendously from one individual to the next.

What to do:  These findings illustrate that virtually all meals purchased outside of the home are staggeringly high in calories.  Meals out are also much higher in sodium and sugar.  So, 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 can help to minimize the time needed to prepare meals.  When ordering out, communicate what you want.  Ask how items are prepared.  Order lighter preparations with sauces and dressings on the side.  Selecting junior meals, boxing up part of the meal for later, sharing an entrée, or ordering from the appetizer or side menus can also be useful strategies to curb calorie content.

Source:

Lorien E, Urban JL. Weber MB, et al. Energy contents of frequently ordered restaurant meals and comparison with human energy requirements and US Department of Agriculture database information: A multisite randomized study.  Journal of the Academy of Nutrition and Dietetics. Jan. 20^th, 2016.  Available online ahead of print. DOI:10.1016/j.jand.2015.11.009

Adapted from articles available at:

https://www.nlm.nih.gov/medlineplus/news/fullstory_156806.html

http://www.sciencedaily.com/releases/2016/01/160120091704.htm
http://www.cnn.com/2016/01/20/health/non-chain-restaurants-calories-fast-food/index.html

PRE-DIABETES HARMS KIDNEY HEALTH

Diabetes is known to be the leading cause of kidney disease and kidney failure.  Excess blood sugar is passed through the kidney, which, overtime, causes damage.  Now, new research finds that even the modestly elevated blood sugar levels of pre-diabetes impact kidney health.  Pre-diabetes affects more than 35% of American adults -- and an estimated 90% of those do not know they have the disease. About half of those with pre-diabetes develop diabetes within 10 years.

The study tracked the kidney function of 595 individuals with pre-diabetes and 729 healthy control subjects over an average of 5.6 years.  Participants ranged in age from 50-62 years.  The investigators found that patients with pre-diabetes had early signs of kidney damage, including high levels of the protein albumin in their urine.

To make matters worse, another interesting recent investigation found that slight reductions in kidney function are an independent contributor to heart disease.  Since persons with kidney disease commonly have other heart health risk factors, such as high blood pressure and diabetes, the direct effect of diminishing kidney function on the heart has been uncertain.  But, this study focused on kidney donors who must not have risk factors for kidney disease.  Researchers tracked kidney and heart health before and over the following year after nephrectomy (kidney removal surgery).  When donors lose a kidney, their kidney function initially drops and then over the following years as the remaining kidney adapts, filtration rates gradually recover.  Researchers found that at 1-year out after their nephrectomy, donors' hearts revealed early signs of damage.   They noted an increased left ventricle size, a strong predictor of elevated heart disease risk.  So, while these results are not of great concern to kidney donors who are a healthy group, they underscore the significance to heart health of even modest losses in kidney function such as that seen in pre-diabetics.

What to do:  These findings illustrate the importance of catching pre-diabetes early and making lifestyle changes that can return blood sugar to healthy levels and prevent diabetes.  The American Diabetes Association defines pre-diabetes as having a fasting blood sugar of 100-125 mg/dL and/or a hemoglobin A₁c of 5.7-6.4%.   Research shows that moderate cardiovascular exercise such as brisk walking for 30 minutes five times per week and a 5-7% reduction in bodyweight can prevent or delay diabetes in those with pre-diabetes.  If you have excess weight or other risk factors for diabetes, make sure your provider is checking your hemoglobin A₁c blood level which often indicates pre-diabetes before fasting blood sugar levels become elevated.

Sources:

Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.  Available online at:  http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html

Melsom T, Schei J, Stefansson VTJ et al.  Prediabetes and risk of glomerular hyperfiltration and albuminuria in the general nondiabetic population: A prospective cohort study.  American Journal of Kidney Diseases.  Published online ahead of print December 29, 2015;  DOI: http://dx.doi.org/10.1053/j.ajkd.2015.10.025

Moody WE, Ferro CJ, Edwards NC, et al. Cardiovascular effects of unilateral nephrectomy in living kidney donors. Hypertension 2016;67:368-377; DOI: 10.1161/hypertensionaha.115.06608.

Adapted from articles available at:

https://www.kidney.org/news/prediabetes-precursor-kidney-disease

http://www.newsroom.heart.org/news/even-small-reductions-in-kidney-function-may-damage-heart-blood-vessels

https://www.nlm.nih.gov/medlineplus/news/fullstory_156445.html http://www.sciencedaily.com/releases/2016/01/160111162754.htm

ACTIVITY IN OLDER ADULTS HELPS REVERSE NEURODEGENERATION IN THOSE WITH MILD MENTAL DECLINES

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:

https://www.nlm.nih.gov/medlineplus/news/fullstory_155965.html

http://www.sciencedaily.com/releases/2015/11/151119113458.htm

Source:

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

     

EVEN AT HEALTHY WEIGHT EXCESS BELLY FAT INCREASES RISK OF PREMATURE DEATH

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.   

Sources:

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:

http://consumer.healthday.com/vitamins-and-nutrition-information-27/obesity-health-news-505/belly-fat-can-up-risk-of-early-death-even-in-normal-weight-folks-705093.html

http://www.theatlantic.com/health/archive/2015/11/the-health-dangers-of-a-spare-tire/415194/

https://www.washingtonpost.com/national/health-science/even-if-youre-thin-excess-belly-fat-can-raise-your-death-risk/2015/11/16/516df774-87ca-11e5-9a07-453018f9a0ec_story.html

http://health.usnews.com/health-news/articles/2015/11/09/belly-fat-is-bad-even-at-a-normal-weight

THE SKINNY ON HOLIDAY WEIGHT GAIN

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.

TREATING INSULIN RESISTANCE MAY IMPROVE DEPRESSION

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.   

Source:

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:

http://med.stanford.edu/news/all-news/2015/11/insulin-sensitizing-drug-relieves-symptoms-of-chronic-depression.html

http://www.medscape.com/viewarticle/854618

https://www.nlm.nih.gov/medlineplus/news/fullstory_155792.html