BLOOD PRESSURE LOWERING DASH DIET ALSO REDUCES GOUT FLARE-UPS

Gout is a painful arthritis that develops when uric acid crystals deposit in the joints.  A new analysis indicates that following the Dietary Approaches to Stop Hypertension (DASH) diet plan can significantly improve gout by lowering elevated blood levels of uric acid.

The findings stem from a new analysis of the data collected in the original DASH diet randomized clinical trials conducted in the '90's.  The DASH diet emphasizes intake of vegetables, fruits, and fat-free/low-fat dairy products and includes healthy amounts of whole grains, fish, poultry, beans, nuts, and vegetable oils while limiting salt, sweets, sugary beverages, and red meats.  Nutritionally, this means DASH is low in sodium and unhealthy saturated fats while being rich in fiber and the blood pressure-friendly minerals potassium, calcium, and magnesium.  The landmark DASH trial reported in '97 revealed following the DASH diet markedly improves blood pressure in hypertensive persons. Now, an analysis of the original DASH study participants' blood uric acid levels reveals the diet also substantially reduces uric acid in the blood.  Impressively, among study participants with elevated uric acid levels, DASH lowered levels by nearly as much as typical gout medication treatment.

The underlying causes of gout remain poorly understood.  Alcohol intake (especially beer), meat intake, diabetes, high blood pressure, obesity, sickle-cell anemia, kidney disease, and diuretic medications are some of the known risk factors for gout.  Gout sufferers are advised to reduce their intake of proteins rich in purine which raises uric acid levels.  One reason DASH is likely good for gout is that it emphasizes lean dairy and plant-based proteins from beans that are naturally lower in purine than meat, fish, and chicken.  It is also believed that gout sufferers' benefit from the variety of anti-inflammatory phytonutrients found in the plentiful fruits and vegetables of the DASH diet.

What to do: If you suffer from gout eliminate alcohol and actively hydrate, drinking 8-16 cups of water daily.  Moderate your intake of meat, shellfish and other animal proteins, and instead get more of your protein from lean dairy, eggs, and beans.  And, given the promising results of this analysis, take steps to adopt the DASH diet.  Detailed information on the diet and meal plans are available online at:  www.nhlbi.nih.gov/files/docs/public/heart/new_dash.pdf

Source:

Juraschek SP, Gelber AC, Choi HK, et al.  Effects of the Dietary Approaches to Stop Hypertension (DASH) diet and sodium intake on serum uric acid.  Arthritis & Rheumatology.  Published online August 15, 2016. DOI: 10.1002/art.39813

Adapted from articles available at:

https://medlineplus.gov/news/fullstory_160435.html

http://www.hopkinsmedicine.org/news/media/releases/blood_pressure_diet_improves_gout_blood_marker

https://www.sciencedaily.com/releases/2016/08/160815064759.htm

BEING WELL HYDRATED ASSOCIATED WITH HEALTHIER WEIGHT

The National Health and Nutrition Examination Survey (NHANES) conducts detailed surveys and physical examinations on a nationally representative sample of approximately 5,000 individuals each year.  It is one the primary ways in which the Center for Disease Control and Prevention tracks the health and nutritional status of Americans.  A recent analysis of adults in NHANES from 2009-12 uncovered an intriguing association between poor hydration status and excess weight.   

For the study, researchers assessed adults ages 18-64, noting height, weight, and urine osmolality.  Results indicated nearly one-third of participants were inadequately hydrated and those who were inadequately hydrated were 1.6 times more likely to be obese, even after they controlled for factors known to effect hydration status.  So, these result clearly indicate a link between obesity and insufficient hydration but it is unclear if there is a causal relationship.  Certainly, people with obesity need more water than people who have smaller bodies, making the hydration threshold potentially harder to reach.  It is also possible that people at higher weights are less likely to practice behaviors that support hydration such as eating fresh fruits and vegetables (which significantly contribute to our fluid intake - a medium  cucumber, for example, contains over 1 cup of water).  Alternatively, poor fluid status may be a contributing factor to obesity.  For example, if an individual tends to eat when they are actually thirsty, they would be more likely to gain weight.  Certainly, there is evidence that overweight/obese persons who drink water before meals lose more weight those who do not.  

What to do:  Whether or not inadequate hydration is a driver of excess weight, maintaining proper hydration is essential to our health.  Even modest dehydration has been found to contribute to problems such as kidney stones, constipation, urinary infections, and headaches.  Mild dehydration has also been shown to decrease mood and depress psychomotor and attention/memory skills.  So, how can you tell if you’re drinking enough fluids? The Institute of Medicine recommends men get 125 ounces (~15 1/2 cups) of fluid from all food and beverages consumed daily while women need 91 ounces (~11.5 cups).  But fluid needs vary considerably depending on individual characteristics as well as weather conditions and activity level.  The most reliable way to tell if you are adequately hydrated is to check the color of your urine. If it is light, almost the color of water, then you likely getting enough.  Avoid high calorie drink choices like soda, juice, and other sweetened drinks.  If you are not a fan of plain old water try seltzer, herbal tea, or flavoring water with lemon, lime, orange, mint, or cucumber.

Source:

Chang T, Ravi N, Plegue MA, Sonneville KA, & Davis MM.  Inadequate dydration, BMI, and obesity among US adults: NHANES 2009-2012. The Annals of Family Medicine, 2016; 14 (4): 320. DOI:10.1370/afm.1951

Information adapted from articles available at:

https://www.sciencedaily.com/releases/2016/07/160712073910.htm

https://medlineplus.gov/news/fullstory_159832.html

http://www.medscape.com/viewarticle/866003

DIET RICH IN MAGNESIUM IMPROVES BLOOD PRESSURE

Diets low in sodium and rich in potassium, calcium, and magnesium are associated with healthier blood pressure levels.  These minerals play a pivotal role in the body's regulation of fluid and the function of the arterial muscles.  Still, experimental trials with supplementation have yielded mixed results, but a recent meta-analysis strengthens the case for magnesium's blood pressure benefits. Researchers pooled data from 34 magnesium supplementation clinical trials with a total of 2,028 participants, to find a small but significant association between magnesium intake and reduced blood pressure, particularly in those individuals whose diet is inadequate in magnesium.

Combining the findings of the different trials revealed that taking about 368 mg of magnesium daily for about three months resulted in overall reductions in systolic blood pressure (the top number in a reading) of 2 millimeters of mercury (mm/Hg) and diastolic blood pressure (the bottom number) of 1.78 mm/Hg.  The effect of supplementation was more pronounced in individuals with inadequate dietary magnesium sources. 

What to do:  These findings underscore the importance of consuming a healthy diet rich magnesium.   The U.S. Recommended Dietary Allowance for magnesium is 310-320 milligrams per day for women and 400-420 mg per day for men.   While a balanced diet rich in plant foods is plentiful in magnesium, it is estimated that 60-80% of Americans do not get adequate dietary magnesium.  Excellent sources include whole grains, beans, nuts and dark green leafy vegetables.  If you feel your diet might be lacking discuss supplementation with your provider.  Do not supplement with high doses of magnesium as it can cause GI symptoms, and impede absorption of other minerals or medications.   Magnesium aspartate, citrate, lactate, and chloride forms of the supplement are better absorbed than magnesium oxide or sulfate. 

Source:

Zhang X, Li Y, Gobbo LCD, et al.  Effects of magnesium supplementation on blood pressure: a meta-analysis of randomized double-blind placebo-controlled trials.  Hypertension. 2016. Published online ahead of print July 11 2016, DOI :10.1161/HYPERTENSIONAHA.116.07664

Information adapted from articles available at:

http://www.reuters.com/article/us-health-hypertension-magnesium-idUSKCN0ZT2LD

http://newsroom.heart.org/news/magnesium-may-modestly-lower-blood-pressure

https://medlineplus.gov/news/fullstory_159836.html

INADEQUATE COPPER MAY HAMPER FAT BURNING

The essential mineral copper has been gaining increasing attention over the past decade for its role in human physiology.  Copper is needed to form red blood cells, absorb iron, develop connective tissue, mediate neural communications and support the immune system.  A new study in mice suggests that copper has another important function – enabling the breakdown of fat stores.

The researchers made the copper-fat link using mice with a genetic mutation that causes the accumulation of copper in the liver. The inherited condition, known as Wilson's disease, also occurs in humans and is potentially fatal if left untreated.  The researchers noted that, compared to the controls, the mice with Wilson’s had lower liver fat stores and greater body fat stores.  The researchers also found that the fat tissue in the bodies of the mice with Wilson's had lower levels of copper compared with the control mice.  When researchers treated the Wilson's disease and control mice with isoproterenol, a substance known to induce the breakdown of fat, they found that the mice with Wilson’s exhibited less fat-breakdown than the control mice.  

Next, working with cell cultures, the researchers sought to clarify the mechanism by which copper influences the breakdown of fat.  They found that copper deactivates one of the enzymes that stops the process of fat breakdown.  This study was the first to uncover the biochemical mechanisms linking copper and fat but not the first to indicate some sort of relationship between copper and fat stores.  Previous work with beef cattle has found that higher levels of copper in feed creates meat cuts with lower fat content. 

What to do: It remains to be seen exactly what role copper plays in human fat breakdown.  The adult Recommended Daily Allowance (RDA) of copper is 900 mcg.  The U.S.  Food and Nutrition Board estimates that only 25% of the U.S. population gets enough copper daily.  Still, limit any supplementation to no more than 100% of the RDA as excessive copper intake can impair absorption of other key minerals such as zinc.  The best way to ensure you have adequate copper levels is to consume a variety of foods rich in copper including oysters and other shellfish, wheat bran, leafy greens, mushrooms, seeds, nuts, cocoa products, and beans.

Source:

Krishnamoorthy L, Cotruvo JA, Chan J et al.  Copper regulates cyclic-AMP-dependent lipolysis.  Nature Chemical Biology.  Available online June 6, 2016 ahead of print. DOI: 10.1038/nchembio.2098

Adapted from articles available at:

http://newscenter.lbl.gov/2016/06/06/fat-burning-copper/

http://thescienceexplorer.com/brain-and-body/copper-plays-key-role-burning-fat-study-suggests

PREVENTING REGAIN: HOW TO KEEP LOST POUNDS OFF

Weight loss, even just 5-7% of bodyweight has been shown to substantially improve heart health risk factors including high blood pressure, high cholesterol, sleep apnea, and insulin resistance/elevated blood sugar.  But, weight loss is notoriously hard to maintain.  A recent study of participants from a season on the “Biggest Loser” presented some disheartening findings.  The report found that six years after dropping an average of 129 lbs., participants had regained 70% of lost weight and their bodies were burning about 500 fewer calories a day than other people their age and size.  This report underscores just how difficult it is to maintain weight loss.  Still, many people do achieve significant weight loss and manage to keep it off.  The National Weight Control Registry (NWCR) is a database of more than 10,000 persons who have lost more than 30 lbs. and have kept it off for more than 1 year.  Investigations of these individuals reveal that maintaining weight loss is an active process requiring just as much focus as weight loss.  Let’s identify the actions that are essential to keeping weight off.   

Alter your mind-set

The key to maintenance is to accept that the changes made in one’s lifestyle during weight loss must be kept up during maintenance.  Choosing healthier foods, taking home half your restaurant meal, lacing up your sneakers for a walk – it is all about making and repeatedly practicing healthier behaviors until they become your new way of living.  It is also important to have a relapse prevention plan and implement it when your weight starts to creep up.  Slip-ups are a normal part of life but preventing slides and getting back on track is essential for effective weight loss maintenance.  Proactively coping with setbacks appears to be another strength of NWCR participants

Tweak rather than overhaul what you eat

When losing and subsequently maintaining weight loss, follow a plan that is not radically different from your “normal” patterns but just different enough that it supports effective weight management.  For example, while people on average lose weight more quickly on very low carb diets such as Atkins, these intake patterns are rarely adopted long-term.  When the diet is abandoned, the carbs come back in and so does the weight.  Instead of eliminating carbohydrates, moderate them.  In general, choose a weight loss plan that incorporates a variety of whole foods, including fruits, vegetables, whole grains, beans, nuts, lean sources of protein, and healthy fats.  Apply the 80/20 concept. Eat healthfully and calorie-consciously 80% of the time and allow for planned splurges.

Control calorie intake

Obesity experts estimate that the metabolic adaptation, or handicap, from weight loss is roughly about 15 calories for every percentage of body weight lost.   For example, if a 250 lb. person lost 50 lbs. (20% of their original weight) than they would need to take in approximately 300 less calories than someone who always weighed 200 lbs.  To compensate for the lower calorie needs, you can eat that number fewer in calories, burn the calories through exercise or do a combination of the two.  It is not known if the metabolism of persons who have lost weight adjusts over time.  In the case of the “Biggest Losers” it appears that the metabolic handicap of weight loss persisted 6 years after the initial loss.   Also, as we lose weight, there is simply less of us so we require fewer calories.  Therefore, after having lost weight we must consume substantially fewer calories than we needed for maintenance before losing weight. 

How do we effectively control calories?  Our environment is teaming with food cues and highly palatable high fat high sugar food choices.  A large percentage of the weight loss maintainers from NWCR record their intake daily.  Journaling is a way to self-monitor intake and stay accountable to yourself about your choices.  Eating similar foods day-to-day is another common behavior of NWCR’ers.  When there is less variation in the diet it is easier for to gauge an appropriate amount of intake and control portions.   Less variety also likely spurs less unplanned eating. 

Exercise, exercise, exercise!

While exercise is often not essential to lose weight, it appears that it is critical to keep off lost pounds. Therefore, it is essential to integrate physical activity into your lifestyle.  90% of NCWR participants get an average of one-hour of cardiovascular activity in six times per week.  The Dietary Guidelines for Americans advises weight loss maintainers get 60-90 minutes of moderate activity most days.  This is twice the general activity recommendation for adults.

It is also important to incorporate resistance training using weights or bands 2-3 times per week.  During weight loss, resistance activity helps to blunt muscle loss associated with weight loss.  Building muscle while in maintenance also helps to combat the metabolic slowdown associated with having lost weight. 

Watch out for TV

Sit less in front of a screen or TV.  Over two-thirds of NCWR participants watch less than 10 hours of television per week.  The average 35-49 year old American watches three times this much!  Monitor you leisure screen-time and rein it in.

Weigh yourself often

Over three-fourths of NWCR participants weigh themselves at least once per week.  Weighing yourself allows you to know when you are gaining weight and need to reevaluate your intake and lifestyle.  If you notice the weight creeping up, implement a relapse prevention plan.  For example, you might re-start measuring your portions and recording intake in a food journal.

Create a healthy environment

Make the places where you spend big chunks of time — your home, workplace, where you socialize — supportive of your healthier weight and lifestyle.  Join an exercise group.  Make activity part of your commute.  Use small plateware, utensils, and containers for your foods.  Engage family members in creating a healthy household eating environment and keep trigger foods out of the house.  Maintain a healthy respect for your own needs that allows you to prioritize the behaviors that help you be well.  The more weight-maintaining behaviors get incorporated into the backbone of your daily life the more likely you are to beat the odds and keep that lost weight off.

Sources:

Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M., Walter PJ, & Hall KD. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, published online May 2, 2016 ahead of print. DOI: http://dx.doi.org /10.1002/oby.21538

Kushner, RF & Bessesen DH.  Lessons Learned From the National Weight Control Registry.  Part 2 of Treatment of the Obese Patient.  2007, pp 395-403.  DOI:  http://dx.doi.org/10.1007/978-1-59745-400-1_21.  Print ISBN:  978-1-58829-735-8.  Online ISBN:  978-1-59745-400-1.

Magkos  F, Fraterrigo G, Yoshino J, Luecking C, Kirbach K, Kelly SC, de las Fuentes L, He S, Okunade AL, Patterson BW Klein S. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metabolism, published online Feb. 22, 2016. DOI: http://dx.doi.org/10.1016/j.cmet.2016.02.005

Raphaelidis, Leia.  Maintaining weight loss: Lessons from the National Weight Control Registry.  Journal for Nurse Practitioners.  2016 (April) Volume 12, Issue 4, pp 286 – 287.  DOI: http://dx.doi.org /10.1016/j.nurpra.2016.01.009

EXERCISE REDUCES RISK OF 13 TYPES OF CANCER

A new research review has found that regular physical activity significantly decreases risk for 13 different types of cancer including that of the colon, breast, and lung.  For the analysis, researchers pooled data from 12 U.S. and European studies to create a database of 1.4 million adults, aged 19 to 98. They then examined whether self-reported physical activity made a difference in risk of 26 cancers.

The report found that even just a couple of hours a week of physical activity significantly reduces individuals’ risk of cancer.  And, if you can do more, the cancer risk reduction is even greater.  In the study cancer risk continued to decline as time spent doing activity increased.  Prior research has linked exercise to reduced risk of breast and colon cancer, but the role of activity on other types of cancer has yet to be clearly established.  In this analysis in addition to breast, lung, and colon cancer, activity significantly reduced the risk of getting cancers of the esophagus, liver, kidney, stomach, endometrium, rectum, bladder, head and neck, as well as leukemia and myeloma.  Activity level appears to especially moderate risk of esophageal cancer.  The study found doing regular activity reduced risk by 46%.  Activity also had a very marked impact on lung cancer risk with a 26% reduction.

No one is certain why exercise seems to help fend off cancer.  Activity has multiple beneficial effects that likely contribute to its cancer prevention benefits.   Physical activity reduces levels of hormones, such as estrogen, that have been linked to different cancers, especially breast cancer.  Activity also helps control levels of insulin and insulin-like growth factor which can promote tumor formation and growth.  People who work out also tend to have lower levels of inflammation.  Their cells appear to be subject to less oxidative stress, and are more capable of repairing damaged DNA that might cause cancer.

What to do:  Get moving!  You do not have to be a gym rat to realize the health benefits of activity.  Do what you can.  Some is always better than none.  Current federal activity guidelines call for doing at least 150 minutes of moderate-intensity activity (such as brisk walking) a week, or 75 minutes of vigorous activity (such as jogging).  These recommendations are primarily based on maintaining heart health but also good guidelines for cancer risk reduction.  How vigorous an activity is depends on your fitness level but in general other examples of moderate intensity exercise include walking briskly (3 miles per hour or faster), water aerobics, bicycling slower than 10 mph, doubles tennis, and ballroom dancing.  Vigorous activities include race walking, jogging/running, lap swimming, singles tennis, aerobics, bicycling more than 10 mph, jumping rope, and hiking uphill.

Adapted from articles available at:

https://www.nih.gov/news-events/news-releases/increased-physical-activity-associated-lower-risk-13-types-cancer

http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/Moderate-to-Vigorous---What-is-your-level-of-intensity_UCM_463775_Article.jsp#.V0dQCfkrKM8

https://www.nlm.nih.gov/medlineplus/news/fullstory_158854.html

Sources:

Moore SC, Lee IM, Weiderpass E et al. Leisure-time physical activity and risk of 26 types of cancer in 1.44 million adults. JAMA Internal Medicine.   Published online ahead of print May 16, 2016. DOI:10.1001/jamainternmed.2016.1548.

McCullough LE, McClain KM, Gammon MD. The promise of leisure-time physical activity to reduce risk of cancer development. JAMA Internal Medicine. Published online ahead of print May 16, 2016. DOI:10.1001/jamainternmed.2016.1521.

GOT A MINUTE? GET FIT!

No more excuses about not having time to exercise.  New research finds that doing just one minute of high-intensity exercise can boost your metabolic health as much as doing 45-minute moderate intensity workout.

The study included 27 inactive men who were randomly assigned to do either short high exertion or longer moderate exertion workouts three times a week for 12 weeks, or to a control group that did not exercise.  The intense exercise included three 20-second “all out” sprints on exercise bikes. It also included a two-minute warm-up, a three-minute cool-down, and two minutes of easy cycling for recovery between sprints for a total workout time of 10 minutes.  The men in the moderate workout group did 45 minutes of continuous cycling at a moderate pace, plus the same warm-up and cool-down as those in the sprint interval group.  At the start and end of the 12-weeks, researchers assessed participant's aerobic fitness level as well as  their body’s ability to use insulin properly to regulate blood sugar levels. They also biopsied the men’s muscles to examine how well their muscles functioned at a cellular level. 

By the end of the study, the endurance group had ridden for a total of 27 hours, while the short interval group had ridden for a total of six hours, with only 36 minutes of that time being strenuous.  Despite the dramatic difference in how long each of the exercise groups had spent working out, by the end of the study, both exercise groups exhibited similar improvements in fitness and blood sugar regulation.   Both groups had nearly a 20% improvement in endurance, significant improvements in insulin sensitivity, and significant increases in microscopic structures in the men's muscles that are related to energy production and oxygen consumption . 

What to do: So, in this study, short intense activity and longer moderate intensity activity  were equally good at improving health and fitness.  But, the very brief, high intensity exercise was much, much shorter, so, if you are having difficulty making time for activity, doing short intense intervals may be an effective strategy to improve fitness.  Try powering up the stairwell at work or Google "high intensity interval training" for lots of ways to get in this type of exercise.  Certainly, high intensity exercise in not appropriate for all persons especially those with heart health problems. (Always talk to your provider before starting a new exercise program.)  If very vigorous activity is not for you, this study also illustrated that the more traditional workout format of sustained moderate intensity activity (such as brisk walking) remains an effective strategy to improve fitness.    

Source:

Gillen JB, Martin BJ, MacInnis MJ et al. Twelve weeks of sprint interval training improves indices of cardiometabolic health similar to traditional endurance training despite a five-fold lower exercise volume and time commitment. PLOS ONE, 2016; 11 (4): e0154075 DOI: 10.1371/journal.pone.0154075

Adapted from articles available at:

https://www.sciencedaily.com/releases/2016/04/160427095204.htm

https://consumer.healthday.com/fitness-information-14/misc-health-news-265/one-minute-is-all-you-need-for-a-good-workout-710408.html

http://well.blogs.nytimes.com/2014/12/10/one-minute-workout/?_r=0

http://www.theguardian.com/lifeandstyle/2015/aug/02/is-one-minute-of-high-intensity-exercise-really-enough-to-get-fit