INADEQUATE SLEEP INCREASES RISK OF HEART DISEASE AND DIABETES

Sufficient sleep is increasingly being recognized as an essential part of preventing chronic diseases such as diabetes and heart disease.  A recent trial conducted at Harvard Medical School, provides further evidence of the detrimental effects insufficient sleep has on chronic disease risk.  Researchers found short-term sleep deprivation caused decreases in metabolic rate, increases in fasting blood sugar, and changes in hormones that regulate appetite.  

In this study, well-rested participants were kept in laboratory residences without access to natural light.  Here, researchers allowed them only 6 1/2 hours of sleep every 28 hours.  After the 3 weeks of reduced sleep, participants’ resting metabolic rate (the energy needed to function at rest) fell by 8%.  Also, after the sleep deprivation periods, their levels of the appetite stimulating hormone ghrelin were higher and their levels of the appetite suppressing hormone leptin were lower.  A recent Mayo Clinic study, in which sleep was limited to 6.5 hours, found similar hormonal changes and also observed that with sleep deprivation subjects consumed on average 529 additional calories compared to those who slept 8 hours per night.  Thus, when we get inadequate sleep, our body burns fewer calories and craves more food. 

The Harvard study also found that after the 3 week period of sleep deprivation, participants had higher fasting and post-meal blood sugar levels.  This means that insufficient sleep significantly worsens risk factors for pre-diabetes and diabetes.  “The participants’ glucose control went haywire…in some cases it went from a healthy level to a level considered pre-diabetes,” wrote the lead researcher.

What to do:  The average working-age American adult gets 6 hours of sleep but the Centers for Disease Control recommends adults need 7-9 hours of sleep each night.  Because too little sleep significantly increases your risk for chronic disease, take your sleep seriously.  Limit leisure TV and computer time if it cuts into your sleep and prioritize keeping to consistent sleep patterns.  Getting regular activity and creating a quiet sleeping environment can help poor sleepers get their shut-eye.  If you have risk factors for obstructive sleep apnea such as upper body obesity, snoring, and/or waking feeling out of breath consider being evaluated by a sleep doctor.

Sources: Nutrition Action Health Letter June 2012, CDC sleep guidelines available at:  http://www.cdc.gov/features/sleep/, article available at: http://newsroom.heart.org/pr/aha/lack-of-sleep-may-increase-calorie-230068.aspx

TOO MUCH SITTING, EVEN IF EXERCISING, INCREASES RISK OF DYING

For better health, try standing up more, a new study suggests.  It found that compared to persons who regularly sit for less than 4 hours per day, those who sit for more than 8 hours have a 15% increased risk of dying in the next 3 years and, even worse, those who spend 11 or more hours a day sitting are 40% more likely to die. Strikingly, the elevated risks for dying from all causes remained even after taking into account participants' physical activity, weight and health status.

For the study, Australian researchers analyzed self-reported data from more than 222,000 people aged 45 and older.  "The evidence on the detrimental health effects of prolonged sitting has been building over the last few years.  Our research indicates that after the 8-hour mark, the risks go up exponentially. It's really about what you're doing in your leisure time and making the decision to move”, said lead researcher Dr. van der Ploeg.   Currently, an estimated 90% of adults’ leisure time is spent sitting.

What to do:  If your job is sedentary, try to take frequent breaks and go for a walk around the work space or simply move in place for a couple minutes.  Because standing time at sedentary jobs is necessarily limited, try to make a greater portion of your leisure time standing, walking or engaging in other movement.  After work, instead of sitting in front of the computer or TV, try to get in some physical activity or do anything else that involves moving around.  If you are watching TV, make a point of getting up during advertisements or try marching in place while watching. 

SOURCE: Hidde van der Ploeg, Ph.D., senior research fellow, Sydney School of Public Health, University of Sydney, Australia.  March 26, 2012, Archives of Internal Medicine

Adapted from article found at:  http://www.nlm.nih.gov/medlineplus/news/fullstory_123382.html

COMPLICATED LINK BETWEEN DIET DRINKS AND HEALTH

Several studies have found that people who regularly consume diet beverages are more likely to have risk factors for chronic diseases (such as heart disease and diabetes), than people who do not drink diet beverages. For example, a recent study tracking 2,564 seniors over time found that those who drank diet soda regularly were 44% more likely to suffer a heart attack or stroke. Still, the researchers also noted that persons reporting daily diet soda use also tended to be heavier, and have less healthy lifestyles.  In this report and other observational studies with similar findings, the association between poor health and regular diet soda consumption does not mean that the actual diet drinks cause health problems.  It is possible that those consuming diet soda also tend to have other unhealthy habits such as poor diet or inactivity. 

An interesting recent observational study that tracked diet soda as well as dietary intake overall concluded that while a small amount of disease risk may be due to diet drink consumption, overall diet quality makes a much bigger difference in chronic disease risk.  This investigation, lead by Dr. Kiyah Duffey, examined data on more than 4,000 Americans taking part in a long-term study of heart health. Participants were ages 18-30 when the study began in the mid-1980s.  Over the next 20 years, 827 study participants developed metabolic syndrome -- a cluster of risk factors for heart problems and diabetes including extra weight around the waist, unhealthy cholesterol levels, high blood pressure and elevated blood sugar.  The researchers found that the lowest risk of metabolic syndrome, 18%, was seen among people who drank no diet beverages and stuck to a "prudent" diet -- one rich in fruits, vegetables, whole grains and fish and moderate in meat and added sugars.  Meanwhile, people who also ate a prudent diet but did drink diet beverages had a modestly higher rate of metabolic syndrome at 20%. Among participants who followed a typical “Western” diet high in meat, refined grain products, and added sugars, whether they drank diet soda or not, their rate of metabolic syndrome was 32%. "I really think it's overall diet that's matters.  It's very important to have a healthy balanced diet," Dr. Duffey said.

It is not clear how diet drink consumption might lead to higher rates of chronic disease.  There is some evidence that frequent consumption of sweet-tasting foods stimulates overall appetite, especially for sweets so that those who drink diet soda also might consume more calories or sugar from other foods.

There is also a body of research indicating that diet drinks are a useful tool in reducing consumption of caloric sweetened drinks and that when persons switch from regular soda consumption to diet soda, their weight and chronic disease risk factors tend to improve.  For example, a recent randomized controlled trial examined weight and cardiometabolic risk factors after six months during which the participants in one group were asked to replace at least 2 regular sweetened drinks with diet drinks and participants in another group were asked to replace at least 2 regular sweetened drinks with water. At six months, while both groups demonstrated improvements in risk factors, there were significantly greater improvements noted in systolic blood pressure, fasting glucose, and weight change compared to the water group.  It appears this may be due to better adherence to sweetened drink replacement in the diet drink group than in the water group.  Participants in the diet beverage group were able to cut down an average of 218 drink calories per day, while those in the water group cut an average of 148.  Thus, studies like this one, indicate that among those who regularly consume sweetened beverages, replacing them with diet drinks may be a more realistic way to reduce unhealthy sweetened drink consumption. Given that approximately 60% of U.S. adults report drinking sugar-sweetened beverages totaling an average of 300 calories per day, finding viable ways to reduce consumption of sweetened drinks is imperative. 

What to do:  Because frequent sweetened drink consumption including juice, soda, and sweet tea is associated with weight gain and poorer long-term health, try to avoid their consumption.   Whether or not diet drinks negatively impact health remains debated.  If you are able to replace sweetened drinks with water, seltzer, or herbal tea, these are likely you best choice.  Still, when really craving a sweet tasting drink, having a diet drink appears to be a better option than having the regular drink. 

SOURCES: Available at http://bit.ly/H0B6aZ. Report adapted from articles available at http://www.nlm.nih.gov/medlineplus/news/fullstory_123495.html,  http://www.nlm.nih.gov/medlineplus/news/fullstory_123495.html, http://www.nlm.nih.gov/medlineplus/news/fullstory_122137.html

WISE PROTEIN CHOICES: AIM FOR VARIETY AND AVOID UNHEALTHY FATS

Foods containing protein include both animal (meat, poultry, seafood, eggs, dairy) and plant (beans, lentils, soy products, nuts) food sources. We all need protein.  It is an essential for the body to maintain and repair all body tissues including your organs, muscles, skin, hair, nails, bones, and hormones.

Try to include a protein source at every meal.  Consuming adequate protein is an important part of a healthy diet.  Sufficient protein intake is especially important when trying to lose weight.  Eating adequate protein while limiting the total calories (energy) of the food you take in allows your body to preserve your muscle and body proteins and burn stored fat for energy.  Without enough protein, the body will break down body tissues for energy and less fat will be lost.  Consuming adequate protein is also helpful when trying to lose weight because protein is more filling than fats and carbohydrates (i.e. grains, starches, sweets). Therefore adequate protein intake helps to keep you full on less food.  Contrary to what many think, consuming extra protein does not make muscles bigger.  If you consume too much food whether from protein, fat, or carbohydrates, the body will store the extra energy as fat.

When choosing protein food sources, opt for a variety of lean sources.  The fat in meat, chicken skin, cheese, and other full-fat dairy products increases blood cholesterol and clogs arteries.  To support heart health, opt for fish, skinless poultry, eggwhites, beans, and nonfat dairy more often.  Limit your red meat intake and when you do have meat, choose extra-lean cuts.  Nut and seed sources of protein are rich in healthy kinds of fat.  Still, all fats are high in energy, so it is important not to overdo even the healthy fats.  To control calories, portion control your nuts servings to ¼ cup or less.  Unlike animal proteins, plant sources of proteins such as nuts and beans are high in fiber that can help to lower blood cholesterol. 

Tips for Making Healthy Protein Food Selections:

1.  Vary your protein food choices –Consume a variety of protein sources. Experiment with main dishes made with beans, soy, or eggs/eggwhites.  Lowfat/nonfat yogurt and cottage cheese are convenient lean sources of protein.

2.  Choose fish twice a week or more - Eat fish and seafood in place of meat or poultry at least twice a week. Select a variety of seafood—include some that are higher in heart healthy natural fish oils such as tuna, salmon, trout and herring.

3.  Make meat and poultry low fat - Choose lean or low-fat cuts of meat like round or sirloin and ground beef that is at least 90% lean. Trim or drain fat from meat and remove poultry skin. 

4.  Have an egg - One egg a day, on average, does not appear to increase risk for heart disease, so make eggs part of your weekly choices. Only the egg yolk contains cholesterol and saturated fat, so egg whites are a great, naturally fat-free protein source.  Consider having one whole egg along with egg whites in a scramble or omelet.  Try egg salad with mostly whites and just one yoke or part of a yoke.

5.  Emphasize plant-based protein options - Try beans and peas (kidney, pinto, black, or whitebeans; split peas; lentils; chickpeas & hummus), soy products (tofu, soy milk, veggie burgers, edamame), nuts, and seeds. They are naturally low in saturated fat and high in fiber.

6.  Choose lean dairy – Like meat, the fat in dairy is high in artery clogging fats.  Cheese, while rich in protein is especially high in fat. Even “part-skim” and “reduced fat” cheese can still contain significant unhealthy saturated fat.  Use cheese sparingly or opt for lowfat or nonfat options.  Lowfat/nonfat milk, yogurt, cottage cheese, and whey protein isolate are good choices for protein.  The thicker, Greek-style of yogurt has 2-3 times as much protein as the regular yogurt. 

7.  Cook without added oil - Instead of frying, try grilling, broiling, roasting, stewing, braising, or baking—they don’t add extra fat. Some lean meats need slow, moist cooking to be tender—try using these in stews or cooking them with a slow cooker. Watch out for items cooked in butter or with cream sauces.

8.  Make a healthy sandwich or salad - Choose grilled chicken, turkey, roast beef, canned tuna or salmon, hard-boiled egg/eggwhites, or cottage cheese for salads and sandwiches. Many deli meats, such as regular bologna or salami, are high in fat and sodium—make them occasional treats only. Use cheese as an accent rather than the main protein source in a dish.  For example, instead of a grilled cheese sandwich, use one thin slice of cheese along with another protein source such as turkey.

9.  Think small when it comes to meat portions - Get the flavor you crave but in a smaller portion. Make or order a smaller burger (consider “Jr.” options) or a “petite” size steak.

10.  Watch the sodium & saturated fat - Check the Nutrition Facts label to limit saturated fat and sodium (salt). Deli meats, for example vary greatly in their saturated fat and salt content.  Salt is added to many canned foods—including beans, fish, and meats.  Processed meats—such as ham, sausage, and hot dogs and most cheese are especially high in sodium. Choose unsalted nuts or seeds.

VITAMIN B12 ENERGIZER SHOTS? UNNECESSARY EXCEPT IN CASES OF DEFICIENCY

Although vitamin B12 injections have a reputation for being a magic antidote for weight loss and fatigue, there is little creditable evidence to support this.  B12 injections can improve energy levels in persons who are B12 deficient but deficiency is relatively uncommon.  According to the 2001-2004 National Health and Nutrition Examination Survey, 3.2% of those over the age of 50 have B12 deficiency. And, there is no evidence that vitamin B12 impacts weight loss.

B12 is an essential vitamin that plays an important role in DNA synthesis, red blood cell development, peripheral nerve integrity, and cognitive function.  When deficient in B12, persons can develop pernicious anemia characterized by fatigue. 

All animal proteins including eggs, meat, fish, and poultry are rich in B12.  Additionally, most wheat is fortified with B12.   In order to for the body to digest the B12 found in foods, first the B12 in foods must be exposed to the stomach’s acids and then it must be linked with a protein made in the stomach called intrinsic factor. 

While rates of deficiency are low, some persons are at greater risk.  As we age, our stomach’s acidity decreases so persons over 60 are more likely to have B12 deficiency.  Also, persons taking medicine for gastroesophageal reflux disease (heartburn) have reduced stomach acidity.  Additionally, a common medicine used to treat diabetes, metformin, is associated with greater risk of B12 deficiency.  Persons who have very limited intake of food sources of B12 such as those who do not consume dairy or animal-based foods as well as persons who have digestive dysfunction such as those with inflammatory bowel disease are also at increased risk for B12 deficiency. 

What to do:  Consume a diet rich in sources of B12 including lean animal proteins such as lowfat dairy, fish, chicken, and lean meat.  If you believe you may be low in B12, consider taking an oral B12 supplement or ask your doctor to assess the B12 level in your blood.  If you are deficient, shots of B12 can be very helpful but, be aware, most B12 shots are not administered to persons who will actually benefit from the supplement.  As long as you have adequate levels, mega-supplementation has no benefit and can be quite expensive. 

Information adapted from article by Consumers Union of United States Inc. for Washington Post found at http://www.washingtonpost.com/national/health-science/vitamin-b12s-reputation-as-an-energizer-exceeds-evidence-deficiency-rate-is-low/2012/04/02/gIQAhxyHrS_story.html

VARICOSE VEINS CAN BE A SIGN OF SERIOUS VASCULAR PROBLEMS

Varicose veins and their precursors, spider veins can signal serious vascular problems.  Full-blown varicose veins appear as twisted, enlarged veins close to the surface of the skin while milder varicose spider veins appear as sunbursts of small blue or red vessels near the surface of the skin.  Spider and varicose veins are often misunderstood as merely a cosmetic problem.  However, if left untreated, spider and varicose veins can progress to a more serious form of vein disease called chronic venous insufficiency (CVI). 

Veins are the vessels that return blood to the heart from the body.  To keep the blood flowing up from extremities, and not back down, the veins contain one-way valves. Failure of  leg veins’ valves to hold blood against gravity leads to swelling in the lower legs and ankles, aching or tiredness in the legs, new varicose veins, leathery-looking skin on the legs, and/or flaking , itching, or ulceration on the skin of the legs or feet.

Varicose veins and vein valve damage is more likely among women, persons over 50, and persons with a personal or family history of leg clots (known as deep vein thrombosis).  Obesity, smoking, sedentary lifestyle, and sitting or standing for long periods have also been found to increase the risk of varicose veins and vein disease.  To prevent and reduce the progression of venous diseases try to maintain a healthy weight, avoid smoking or quit if you already smoke, exercise regularly, and avoid long periods of standing or sitting.  Elevating your legs to the level of your heart when sitting or lying down as well as wearing compression stockings can also support  venous blood flow in the lower extremities.

It is estimated that more than 40 million Americans suffer from vein disease but less than 3% get treated.  Because varicose veins are a potential risk factor for vein disease, persons with varicose veins, should have their risk for CVI assessed and be treated when indicated.  A vascular ultrasound can examine the blood circulation in the legs.  Non-surgical treatments for existing varicose veins and spider veins include sclerotherapy in which an injection into the veins causes them to collapse and disappear and endovenous thermal ablation in which laser or high-frequency radio waves create intense local heat in the affected vein causing it to close.  For more severe cases, surgical venous stripping or ligation may be necessary.

What to do:  To maintain healthy veins in the legs aim for good cardiovascular health by not smoking, maintaining a healthy weight, and exercising regularly.  Also, try to avoid long periods of sitting or standing.   If you are traveling or will be sitting for a long time, flex and extend your legs, feet, and ankles about 10 times every 30 minutes to keep the blood flowing in the leg veins. If you need to stand for long periods of time, take frequent breaks to sit down and elevate your feet.  If you are experiencing varicose veins or other symptoms of leg vein disease, discuss assessment and treatment options with your provider. 

Sources:  “Chronic venous insufficiency.” Vascular Web. Society for Vascular Surgery, Jan. 2011. Web. http://www.vascularweb.org/vascularhealth/Pages/chronic-venous-insufficiency.aspx and Gloviczki P, Comerota A, Dalsing M, Eklof B, Gillespie D, Gloviczki, M, et al.  The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011 May; 53(5 Suppl): 2S-48S.

RESEARCHERS PINPOINT HOW A LACK OF VITAMIN D MAY INCREASE THE RISK OF ALZHEIMER'S AND VASCULAR DEMENTIA

Researchers have found that low blood levels of vitamin D are associated with an increased risk for a host of health problems ranging from cardiovascular disease, susceptibility to infections, and diabetes, to osteoporosis, dental cavities and periodontal disease.  Vitamin D deficiency is also known to be linked to an increased risk of Alzheimer’s and vascular dementia.   For example, recently, a study from the large Third National Health and Nutrition Survey (NHANES III) in the U.S. showed a marked association between vitamin D deficiency and risk of dementia.   According to the latest estimates, 5.3 million Americans have Alzheimer's disease and it is the seventh-leading cause of death in the U.S

In 2009 it was reported that vitamin D3 appears to stimulate the immune system to clear harmful amyloid beta proteins, the main component of plaques associated with Alzheimer's disease.  But, the researchers didn't know how it worked.  Now researchers have identified the cellular mechanisms regulated by vitamin D3 that help the body clear the brain of amyloid proteins.

For the study, scientists drew blood samples from Alzheimer's patients and healthy controls and then isolated critical immune cells from the blood called macrophages, which are responsible for gobbling up amyloid beta and other waste products in the brain and body.  The team incubated the immune cells overnight with amyloid beta. An active form of vitamin D3 which is made in the body was added to some of the cells to gauge the effect it had on amyloid beta absorption.  They found that vitamin D3 activates key genes and cellular signaling networks to help stimulate the immune system to clear the amyloid protein. 

To determine whether vitamin D supplementation may help to treat dementia, clinical trials are still needed.  It is too early to know whether supplementation with vitamin D can reverse or slow the course of dementia.

What to do:  To reduce your risk of inflammatory diseases such as Alzheimer’s and heart disease, aim to maintain a healthy weight and lifestyle as well as adequate vitamin D.  For vitamin D, consume food sources rich in vitamin D such as lowfat/nonfat milk and oily fish such as salmon.  Also, next time you get blood work with your regular doctor, you can request your vitamin D level be checked.   This way you can know if you are deficient or not and how much to supplement with.  Vitamin D3 is widely available in supplements.  To maximize uptake of vitamin D, it is best to take it along with calcium.  Persons with some conditions should not supplement with vitamin D so check with your doctor before starting supplementation.  

Adapted from content in:   Journal of Alzheimer's Disease, 2009 17:1 & 2012;29:51-62, Science Daily at http://www.sciencedaily.com/releases/2009/05/090526140747.htm and Medscape at  http://www.medscape.com/viewarticle/760305.