Should smokers exercise?

   Smoking is an independent cause of heart disease.  One possible link between smoking and heart disease is that smokers’ arteries tend to be stiffer than the arteries of non-smokers, even when controlling for other factors that might lead to this condition, e.g., having a family hx of heart disease.  Physical activity is also independently related to heart disease - being active reduces the risk and sitting around increases it - to be clear - sitting around for extended periods of time (independent of how active you are otherwise) is associated with the risk of heart disease.

   New research from a small study of young men¹ suggests that smokers who engage in regular physical activity have less stiffness of large arteries than smokers who do not engage in regular physical activity.  However, the stiffness in active smokers was worse than that of active non-smokers, and clearly the best option is not to smoke.

   When I read the study conclusion, I wondered how they measured smoking?  For instance, did they say, ‘in the last month have you had at least one cigarette’ and then put all the yes's in the smoking group and the no's in the nonsmoking group?  If that were the case, I would discount the validity of the conclusion because a person who is physically active and otherwise healthy, might by chance, have had one cigarette in the last month, whereas a physically inactive smoker might have smoked 2 packs a day. That was not the case; the researchers categorized smokers as those who had at least 8 to 10 cigarettes every day during the past two years.  

   Unfortunately, there were other limitations of the study which give me pause, though they do not diminish my faith in the benefits of exercise.  In this small study, the inactive smokers were different in other ways that could lead to heart disease, i.e., they were older, had higher % body fat and smoked more cigarettes per day than the active smokers.  In addition, the average age of the participants in the study was 22 and artery stiffness and other markers of heart disease usually occur later - even those associated with smoking.

   Still: Physical Activity is the sine qua non of health and experts recommend it for EVERYONE.  Smoking is the sine qua non of disease and experts recommend it for NO ONE.  I pride myself in being pro exercise and anti-smoking; but I am not anti-smoker and so I got my dander up when I read the following facebook post of one of my acquaintances.  

Just saw the most bizarre thing ever. Two older ladies walking through (x) Park at a decent pace (clearly here for exercise) then one of them lights up a cigarette and they keep on walking. Why bother exercising?!? At least she can enjoy her death stick in some pretty scenery I guess

   First,  I one hundred percent agree that the park should be tobacco free and I would be furious and loud mouthed about someone smoking near me as I walked, ran or cycled, but that is not what this facebooker was venting.

   The person who started the post, and most of the people who commented on it, wanted to know why the smoker was bothering to exercise - the people speaking on the thread were clearly anti-smoker - if we followed their line of reasoning that a smoker shouldn’t bother to exercise (because they were killing themselves with the cigarettes), then smokers should also stop wearing seat belts or looking both ways when crossing the street.  Ridiculous, judgmental, nonfactual discourse.

   For goodness sakes - EVERYONE should exercise and not all smokers die from smoking related diseases…. maybe because they are otherwise healthy or genetically protected – still, it is not smart to smoke, but it is even less smart to do all the other reckless things on top of it.

Now, put those cigarettes down and go take a walk.

¹ Park, W., Miyachi, M., & Tanaka, H. (2014). Does Aerobic Exercise Mitigatethe Effects of Cigarette Smoking on Arterial Stiffness? The Journal ofClinical Hypertension.

Cholesterol Lowering Drugs

   To my knowledge, there is little evidence to support broad use of statins - or medicines that lower cholesterol.  The goal for treating high cholesterol is to decrease risk of heart attack and early death.  The research I have reviewed only showed this benefit for statin users who have been diagnosed with heart disease or who have had a heart attack.  It is that group that benefits from use. The new recommendations are to give statin medications based on factors (like having diabetes) other than a persons blood cholesterol level.  In a way, this removes the argument of how high the LDL level has to be before medicine is prescribed and at what dose should the statin be started, based on that LDL number.  The cut off number was always arbitrary.  How could there be more risk at 120 and not 119, for example.  But I don't know that this is any better, because it still places an emphasis on pills over lifestyle.
   I share the concerns of CNNs Dr. Sanjay Gupta who equates this shift to medication over changes in diet (and exercise) as a sign of defeat against the prevention of diseases associated with obesity.  Medication is not the solution here and we shouldn't give up on prevention.
    I understand that efforts to nudge people into better lifestyles has not been successful.  I don't think encouraging people to rely on medicine to fix problems is better than changing the environment to provide people better options (i.e.,  options to be physically active and to eat in moderation).  It does seem that nutrition information and nutrition guidelines are consistently and broadly misunderstood by a majority of persons.  This is in large part due to the complicated and ever changing information out there.  It is confusing and most people don't know what to look for when assessing a food's nutritional content and 'healthiness.'
    Just recently, I walked by a man and woman at the grocery store as the man was reading the back of package nutrition label.  (YAY!)  I heard him say, "Oh no, this is loaded with carbohydrates."  I wanted to stop, go back and ask him,"And what exactly does that mean to you?  Why is that a good or bad thing?"   Because if all someone told me was "its loaded in carbohydrates," I could not make an informed decision.  Sugar is a carbohydrate, so are vegetables and grains!  
   Our education and health promotion efforts must be constant, but simplified. Americans consume diets that are high in calories and items that might lead to high cholesterol, diabetes, obesity, heart disease, etc.  The main objective to improve health should be changing the diet (and increasing activity) not medicating the entire country.  Using medication in this way is as foolish as providing more rescue workers to collect the drowning from the river instead of putting a rail on the bridge to keep people from falling in the river.

Red Meat Afoul Again?

   The recent research suggesting a link between a chemical found in red meat and adverse health is important.  It should be considered in much the same way as research that suggests saturated fat is a health risk.  Something is going on and it makes sense to eat less red meat if you are currently eating it more than say... 3x a week.  Some, like me, may choose to not eat it at all.  
I am a vegetarian, so to speak, as I eat fish.  
   When studying red meat consumption and health, the comparison group is often vegetarians or vegans.  Therefore, what science has not concluded is if there is something else about people who are vegetarians, or something else about the vegetarian diet that is protective for health.    For example, if a vegetarian and a meat eater are both eating 1600 calories a day, meat eaters have to be eating less of something that vegetarians are eating more of.  Current theory is that the fiber rich diet of vegetarians may be a key factor.
   In addition, studies often look at dose.  Vegetarians who eat no red meat at all are at one end of the continuum and heavy meat eaters who consume 3 or more servings each day are at the other.  In either case, as the red meat consumption goes up, so does the chemical and the sat fat content, but something also goes down.  It is likely that both conditions - too much of one thing and too little of the other(whatever the other is) is causing the health risk.  With that thought, there will surely be a difference in outcome based on what replaces the red meat in a person's diet.  These are things we have to study more.
  Bottom line.  There is reason to believe that we can eat too much red meat and "too much" depends on who you ask.  It is reasonable to replace some of your red meat with lean proteins and some types of fish, like salmon.  On an individual level, meaning your diet, direction should come from a licensed dietician.

Reconsidering Saturated Fat

I find myself in crunch time again, but wanted to get this different point of view out to you .
   I have been a strong advocate for avoiding saturated fat and have oft described myself as a saturated fat phobic, calorie aware semi vegetarian.  That is for the most part still true of me.
It is also true that I consider research and commentary that comes form Harvard School of Public Health and Yale's Research Centers to be of high quality.  So when David Katz, MD MPH from Yale wrote a blog stating that some of the food constituent extremists... ('fat' is bad, 'sat fat' is bad, 'trans fat' is bad, 'sugar' is bad).might missing a point or two, it gave me pause.
   Dr. Katz is not saying that saturated fat is without problems or that it is not linked to heart problems (it may have a role in thickening or hardening of the arteries for instance).  What he does say is that the problem with diets high in saturated fat and or high in sugar... or similarly, diets high in fried foods and refined grains (e.g., cakes, pastries, white pastas and rice) are likely to be LOW in the foods that we know are healthy or which protect against heart disease (e.g., fruits, vegetables, beans, whole grains).
   I am going to link you to his post, even though I don't agree with all of it and don't like how his page is full of ads.  I don't have time to go into more detail for you and do want you to hear his points.
Here is his post.    

Odds and Ends

F as in Fat The 2012 report from RWJF and the Trust for America's Health will be released soon.  This week a press update offered news on disappointing and compelling trends.  The majority of states have an adult obesity rate of 25% or higher.  Twelve states have rates of 30% or higher and when rank ordered, the 30 heaviest states include 7 from the South.  This speaks to regional food norms.  In the South one can expect foods to be deep fried, rich, sweet and salty (maybe not all at once!).  It is also custom in the South to eat what you are offered and for those offerings to be generous.  The pending report form TFAH and RWJF will offer suggestions on curbing the obesity epidemic and the benefits that we can expect from certain strategies.  
We're # 1 I passed a billboard that proclaimed hospital X to be number one in heart surgery. I considered this to be evidence that hospitals are competing for customers.  There must be a significant number of them (or why advertise on a billboard).  A great many Americans have or will have heart disease - in fact, the odds of dieing from it are pretty high.  It is the number one cause of death here.  The hospitals know this and can profit from it.  They must - billboards are not cheap.  Incidentally, the current HSPH newsletter has a link to a blog post by one of their esteemed staff on the topic of hospital ratings.  The blogger discusses how a hospital can be scored differently by 3 credible sources. It is a great, MUST read.  Click HERE.
MCR (medicare)  Not to be political but to acknowledge a topic that has become political.  I have been listening to the public discourse and in the interest of full disclosure, I support the Affordable Care Act.  The ACA has benefited Medicare recipients that I know personally.  Still, there may be a future where persons over the age of 67 are seeking health care coverage as primary payers of that coverage.  Perhaps they will have vouchers.  In order for such a person to find the best coverage for the least amount of money (premium, copay, deductible) they will need to be healthy and not smoke.  The insurance companies will probably SEEK out healthy active seniors in order to reduce losses related to costs of covering non healthy older adults.  The majority of older adults are currently and will continue to be unhealthy.  Half of all adults now suffer from at least one chronic disease associated with being inactive and or overweight.  (increasingly adults have more than one disease, i.e arthritis and diabetes)
     You won't be able to change your past, but you have some control over your future. Get some amount of exercise every single day, always be aware of the foods you are consuming - aim for quality in the proper quantity, avoid all cigarette smoke.

Your Numbers - Your Risks

   Before we move on to another topic, I want to assure myself that the information I shared with you yesterday made some kind of impact.

from the American Heart Association website

   Did you view any food labels today?  Were the trans fat grams high or low?  If they were not 0 to 0.5  then they were high.
   Do you have any existing health condition that makes avoiding trans fat especially important?  (heart disease, high blood pressure, diabetes)
   Is there any reason to avoid trans fats if you do not have those conditions?  YES.  Do normal weight people need to avoid trans fats? YES.  Do people who exercise every day? YES.
   Not sure what I am talking about?  Maybe you missed yesterday's post. You can review it here.



 

Which Risk Matters Most?(repost with new link)

Due to the level of importance this post is being republished today. The topic includes the importance of waist circumference as a marker of disease risk. Click here to learn more and to see a picture on how to use a tape measure to get your WC number.   

Dr. Michael Miller, a heart doctor and professor, recently answered some questions about heart disease as it relates to metabolic dysfunction.  Metabolism has to do with how the body breaks things down and processes them.  Certain tests can tell us if the body is having difficulty with those activities, because if it is, health problems could follow.   
   The article with Dr. Millers suggestions is published in the Nutrition Action News Letter July/August 2012 issue.  Within that piece, is a reference to a study that showed the increased risk of both heart disease/attack and diabetes incidence with each factor of metabolic dysfunction that a person has.  The figure from the article was originally published in the AHA journal Circulation.  You can access the article here, for free.  I include the figure below, as it is one of the best representations I have seen.
   First let me explain what factors make up the Metabolic Syndrome while noting that the importance of each one is the subject of debate amongst professionals/scientists.  The 5 factors that were the focus of both the AHA and Dr. Miller articles are:

• Blood pressure equal to or higher than 130/85 mmHg
• Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
• Large waist circumference (length around the waist):
  
  • Men - 40 inches or more
  • Women - 35 inches or more
• Low HDL cholesterol:
  
  • Men - under 40 mg/dL
  • Women - under 50 mg/dL
• Triglycerides equal to or higher than 150 mg/dL

   A person is said to have Metabolic Syndrome if they have any 3 of the above 5 conditions.  As I said, not everyone believes that each is a factor in heart disease nor that each has the same level of impact.  Dr. Miller's assessment makes the most sense to me, based on other articles I have read.  The two most important factors that he notes are triglycerides(TG) and waist circumference (WC).
  Dr. Miller has some quote worthy comments for you to consider, they include:

When the gut is the first thing you see when a patient walks in the door, that is not a good sign

....a lot of men have disturbed metabolism before they reach 40 inches (WC).

Even too much of the right foods can be a problem.

People shouldn't douse their salad with olive oil or they might get too many calories. (in response to a question about healthy oils - douse means use a lot!)

    He also spoke to the issue of getting your TG levels from a health fair, which usually does not include a fasting level.  He said that he has heard of people having a TG level of 400 and being told not to worry about it because it was not a fasting level.  He contends that someone should very much be worried about that level because even immediately after an "unhealthy" meal the TG levels do not rise more than 50% - though they may, in rare instances, double.  So if ones non-fasting TG level is 400, then their fasting level could be 200 and that is TOO high.
   The good news is that TG are directly and substantially reduced through exercise and meal patterns.  Exercise causes the body to release an enzyme that breaks down TGs.  Also, limiting sugar and saturated and trans fats is important.  Dr. Miller recommends very little added sugar - 24 g a day.  He enthusiastically recommends fish oil - but in fish not capsules. There is more but you get the idea.
     Below is the chart I mentioned earlier.  Notice how much higher the risk for adverse health outcomes is when a person has 4 or 5 of the risk factors.  The figure is more readable if you go to the article.

 

Odds and Ends

Whooping Cough According to the CDC, the US is having its worst whooping cough outbreak in 50 years.  Whooping cough is the common name for the bacterial infection, pertussis. The"nickname" is related to the symptoms not the cause.  People who have the infection are contagious during certain periods and the illness can spread to others who are not immune.  Vaccines are effective at preventing both the spread and contraction.  In other words, vaccines protect against getting it yourself and giving it to others.  Most of us received the immunization as children in the DPT shot and its booster.  Many colleges require young adults to get a booster before allowing them to attend classes. The CDC is suggesting that adults may need to get a second booster as well – to protect children.  It appears that the outbreak is related to adults getting sick (often because they have lost their immunity) and infecting children who have not yet had their series of shots.  The number of cases for the year so far are 18, 000.

Helmets and Leaders   I rode my bike on some Greenway trails today.  At one point I came upon a small group.  The group consisted of one man, late 20s, and ten or so children who appeared to be middle school aged.  We were riding in opposite directions so we came face to face.    ALL of the children were helmeted.  It is the law in NC to wear one if you are 16 or younger, but many children do not wear them and the law is not enforced.  The adult in the group was the only one not wearing a helmet. One of the children, a boy, rode off the paved trail into the street. As the boy went off the trail, the adult said, “Tommy, you are not being a very good leader right now.”  And – well – you know what happened next right?  As I rode by, I looked at the man and said – with a light tone, “Neither are you and tapped on my helmet.”  He said, “I know!”

Blood Cholesterol and Heart Disease  This segment can be brief or long and complicated.  I am only just beginning to wrap my mind around what I am learning and the little research I did today is not enough.  Briefly then:  The link between blood cholesterol and atherosclerosis (heart disease due to plaque buildup) is being challenged by many scientists.  It has been debated for a while. One of the arguments is that not everyone who has heart disease has high cholesterol.  It may be that a person’s cholesterol becomes high when other risk factors are in play.  For example, not exercising, smoking and being obese are risk factors for heart disease.  These factors may change the way that the body handles excess calories from fats and sugars and thus the cholesterol that the body creates from them.  I am not sure what this means in the end or what you should do with the information.  I have read that cholesterol lowering drugs should be considered only after weight loss and increased activity have begun. Also that when used; only the least amount of drug that is effective should be given.  There is little evidence to support that lower numbers are better because the cholesterol may be a symptom of some other problem.  For example, if being 30 pounds overweight is causing the sterol to form in the arteries, then having an LDL of 100 while still being overweight is not going to help.

 

News from AHG The information presented below is directly from an email I received from the Alliance for a Healthier Generation.  The goal of the organization is to improve the health and wellbeing of children.  Please go to the websiteto learn more.  The tips that are offered below can apply to adults as well.  If you don’t want to use playground equipment or play tug of war, you can get your resistance training with free weights or exercises that use your body as the muscle load. What I liked best from the email is highlighted in yellow below.   I also like the definitions and examples.

Aerobic Activity: Endurance activities that get muscles moving in patterned movements for a sustained period of time.

Try: Bicycling and swimming

Muscle-Strengthening Activity: Resistance training that increases skeletal muscle power by doing more work than in daily physical activities.

Try: Using playground equipment and playing tug-of-war

Bone-Strengthening Activity:

Impact and tension activities that help grow and strengthen skeletal system.

Try: Running and jumping rope

Different Bodies Are Better at Different Things

Did you know that running a mile at the same speed will have a different effect on different bodies? Lifestyle, metabolism and fitness level all play a part in how exercise affects our bodies. This is because we expend energy at different rates. But with some effort, we can influence that rate.

A body trained to sit, will sit well. A body trained to move, will move well. 
How active is your body?

Inactive: No activity beyond baseline activities of daily living   

Low Activity: Activity beyond baseline but fewer than 150 minutes of moderate activity a week  

Medium Activity: 150 to 300m of moderate activity or 75 to 150m of vigorous activity a week

High Activity: More than 300m of moderate activity a week  

Million Hearts

In September 2011 the secretary of the Department of Health and Human Services announced a campaign that has at its goal the reduction of heart attacks and strokes. Specifically, the CDC and the Centers for Medicare Services are teaming with the AHA, the YMCA, Walgreens and others to reduce the actual number of cardiovascular events by one million.  One million less by 2017.  Heart disease is currently the number one killer of Americans and it is in most part preventable. 
It is two months since the press release and I have not heard anything about this campaign.  I only read about it in a health publication this week.  The campaign is supposed to include an educational piece and I guess as a health educator myself, I can help out by sharing the information with my readers.
The website is another great place for you to get information. You will find some interactive tools on the webpage that can help you personally identify risk factors and strategies for prevention.
What I like best about this initiative is that it targets both prevention and treatment.  Improving care for people who already have high blood pressure or high cholesterol  with adequate medication is a treatment focus.  Reducing the numbers of persons who need to take medicine for blood pressure or high cholesterol (ever) is the preventative piece.
For treatment purposes, the initiative focuses on the ABCS.  You should recall that they stand for taking an aspirin a day, managing blood pressure and cholesterol, and quitting smoking.  Another goal of a Million Hearts is to reduce the current number of smokers by 4 million.  
So my two favorites are 1) keeping people from ever needing to take drugs (this is achieved through exercise, weight control, diets low in sat fat and sodium, avoiding excess alcohol and any tobacco smoke) and 2) four million fewer smokers :)


Again - there is a website with a lot of helpful information on the program and on heart health in general - Please click here.

TLC and all the Cs

I have been reading a little lighter fare today - an article in the ACSM Certified News.  The article is about cholesterol factors that are related to coronary heart disease and risk of a cardiovascular event - such as a stroke or heart attack.

Most of us are familiar with the Cs that are tested in annual blood work and the article gives a great overview and glossary of them.  This includes the values associated with the tests.  Sometimes we aim for a higher value and other times a lower one.  In either case, they are a risk factor for disease. 

The tests include:
TC = total cholesterol
HDL-C = high density lipoprotein cholesterol
LDL-C = low density lipoprotein cholesterol
TG = Triglycerides (another blood fat)
VLDL - C = very low density lipoprotein cholesterol

Each of the above tests has a target value and usually a person is trying to get below that number - i.e. below 200 for the TC.  But the HDL value is one where we want to be high.  If that value is above 60 it actually can protect a person from a heart event.  You can read more about specific target values here.

The article describes a newer test as well.  It is not at this time recommended as part of the adult cholesterol panel, but  is used with persons who have very high TG - diabetics often have high TG even when they can control their LDL.
The new value is called Non-HDL and is the difference between TC and HDL.  Literally - take the total cholesterol value and subtract away the high density lipoprotein value and that is your NON-HDL value - if you do not have heart disease and have less than 2 risk factors for heart disease (i.e. your other values are normal) than your Non HDL should be < 190. 

All of our cardiovascular risk factors can be addressed with TLC - that stands for therapeutic lifestyle changes.  TLCs that you may be familiar with include exercise, changes in what you eat (i.e. less red meat and more fish) and weight loss. Learn more about ways to improve your health and prevent heart disease at the American Heart Association website.
Here is the info on the article I referenced today:
Title: LIPIDS AND HEALTH; A GUIDE FOR THE FITNESS PROFESSIONAL
BY: WILLIAM SNYDER; CHANG CHAU; AND SARAH MAKOSH;
AND JAMES R. CHURILLA, PH.D., MPH, M.S., RCEP, CSCS
IN: ACSM’S CERTIFIED NEWS • APRIL—JUNE 2011 • VOLUME 21: ISSUE 2

Who DOES listen to the guidelines?

Some one that I care about is in the hospital recuperating from heart surgery.  In his own words, this is why he had the surgery:

"The surgery is to repair my mitral valve which is leaking severely and stressing my heart.  The surgery is long and requires being on a heart-lung machine. Mitral valve prolapse was one of the underlying conditions contributing to"    

... his brothers sudden death from arrhythmia (my dad's heart attack death was also related to an unstable arrhythmia).  My friend also told us that his arteries were clean and clear and this allowed for a laproscopic surgery which is less invasive though heart surgery is always invasive.  

The surgery is over and I have followed my friends progress on line and I visited him today. 

He let us know what his first meal was - a "lovely" tray of scrambled eggs, bacon, oatmeal, fruit, biscuit and bagel with juice and milk. 
We (you and I ) recently reviewed the Dietary Guidelines for Americans and I recall mentioning that there  was no harm in eggs for most persons, and this is true, but BACON!!  The man just had heart surgery!  Here is the paragraph from the DGA 2010 -

In addition to being a major contributor of solid fats, moderate evidence suggests an association between the increased intake of processed meats (e.g., franks, sausage, and bacon) and increased risk of colorectal cancer and cardiovascular disease.

I told my friend to get out of there as soon as possible because his arteries were NOT going to stay clear under those conditions.

More than 20% Wrong

A study that was published in the Journal of the American Medical Association recently made the popular press yesterday.  It is a review of hospital records (primarily of medicare/medicaid recipients) from 2006 to 2009 that list ICD procedures.  An ICD is better known to us as a defibrillator but the full name is implantable cardioverter-defibrillator.  The device can restart the heart or shock the heart back into normal rhythm.  A great overview on the device, the diseases it treats, the difference and similarity to a pacemaker and more, can be found at the NHLBI website.  To learn more about who makes them and the industry aspect I had to go to the Wall St Journal and search, and you can read on that as well.

The ICD was developed to treat arrhythmia or heart beat irregularities and it was tested in a certain population for which it was approved for use.  As you know, once a device or drug is approved for use, a physician may use that same device or drug in patients that do not meet the sanctioned criteria, but device and drug makers are not supposed to market the device or drug for anything outside of the original application and testing (unless they test again)

I am not saying that the device makers tried to influence clinicians - except that I most certainly suspect that they have.  According to the research described in the JAMA article, the 22% of people who recieved the defibrillators  outside of the "guidelines" suffered a much higher percentage of serious adverse events.  The people who should not have an ICD under most cicircumstances are those who have recently had a heart attack (40days),  have a new diagnosis of heart failure, who have had surgery to clean out arteries - and subsequent stent placement and a few other criteria.  What I was not able to find were the actual practice guidelines.  I could find articles about them, but not the guidelines themselves.  Certainly, there are some cases were a person is outside of these conditions who would benefit from the device, but it would not be so frequent.

I feel that the issue of over medication and over testing and over "devicing" is not only a waste of resources, but as the JAMA article suggests, can lead to unnecessary death.

(email readers, click on the yourhealtheducator link and check out the new template - looks like wasa crackers :))

Lipemia

Postprandial Lipemia, Endothelial Dysfunction, Oxidative Stress, Atherosclerosis

So what does all that mean?  What part matters to you?  Should I just cut to the chase?

Postprandial is after a meal
Lipemia is fat in the blood (from that high fat meal you just ate) and is also called lipidemia
Endothelial dysfunction is the chemicals that are met to protect the lining of our arteries become unable to do their job. I.e. when the lining of your arteries are adversely effected (nitric oxide protects our artery walls and it becomes depleted under extreme oxidative stress) and plaque can build up
Oxidative stress is when the actions of our body on a cellular level leave a residue that can build up and cause damage - to our artery walls for example
Atherosclerosis is  thickening of the artery from the plaque buildup that occurs when we have excess oxidative stress and endothelial damage!

The only real new thing here is the lipemia story -

I read an article about this today in the ACSM's Certified News and it was incredibly technical. 

As a population, we know that we should limit red meats and saturated fat and because most of us do not,  statin medications are very popular.

This research is indicating that there is more to it than bad cholesterol and that at each high fat meal, damage occurs and this damage accumulates.  What did help in this study, was exercise. 

Scientists can measure the after meal blood fats and the chemical reactions that occur in the body.  Here they had people walk on a treadmill a couple of hours after the high fat meal and  learned that there was an immediate response - less endothelial dysfunction.  People who were very physically active to begin with, had less of a bad response to the high fat meal right after eating and if they too exercised after the meal, the dysfunction was decreased.  It sounds like the type, frequency or duration of the exercise is not important for this particular issue.  Exercise increases the odds that the chemicals that protect the arteries are working properly.

Take home message - DO limit saturated fat and DO exercise regularly - remember Exercise IS medicine - without the side effects.

The review that I read was in  ACSM's Certified News July-September 2010; Vol 20:3

The Meat of the Matter

The red meat association with colon cancer has gained acceptance in the public health community in the last few years. The most established causal link is related to processed meats and eating meats that have been grilled at extremely high temperatures as in both cases chemical agents are created and are hazardous to the body. With colon cancer there is also a synergistic effect with a diet low in fibrous foods. There does continue to be some debate over colon cancer causation.

What has been less challenged is the deleterious effect of saturated fat in red meat, especially in regards to heart disease. A study recently published in the journal of the American Heart Association found that consumption of red meat itself did not correlate to new cases of coronary heart disease. However, there WAS a significant relationship between processed meats and heart disease and possibly diabetes as well. The concern is related to both nitrates and sodium. A high salt diet, especially as it can lead to hypertension, is damaging to artery walls and that damage - inflammation for example, can lead to plaque buildup. Processed meats include lunch meat, bacon and sausage. What did not bear out as a risk factor was eating a steak for example. However, saturated fat does increase caloric density. For that reason, serving size and frequency of consumption must be moderated. The serving size is 3-4 ounces and the frequency is just a few days a week at most. Saturated fat is a problem as is overconsumption of any nutrient which can lead to obesity and the host of problems that involves.

Take home message is that though red meat intake may not be as severe a threat as once thought, it is still something that should be moderated.

The research was one that reviewed over 20 other studies for outcomes based on the food histories of the persons involved. It is not a controlled experiment or clinical trial so the force of the conclusion is somewhat diluted. You can see the abstract of the study here.

Remember also that the AHA has many great resources on its website, including guidance to prevent heart disease in what it calls the Simple Seven.

Peri WHO?

It is still Heart Health Month in America, so I will take advantage of some political news to discuss a heart condition that has not yet been discussed in my blog . That should be a clue that I am not going to talk about Clinton or Chaney. As they both have heart disease conditions that are often related to genetics, environment and lifestyle.
The politician I am referring to today, is Umaru Yar’Adua, the president of Nigeria, who has not been presiding, if you will, due to being hospitalized for treatment of his pericarditis.

This is a condition that involves the protective sac that surrounds the heart. This area is called the pericardium. In medical terms, the ending of words often indicates the type of disease process. Like alga (pain) and osis (increase in) and itis (inflammation). So a person who has pericarditis has inflammation of the sac that surrounds the heart. The redness and swelling occurs because of rubbing in the pericardium.

There are a few diseases that cause the pericardial inflammation, so that pericarditis is usually a symptom of another illness. Doctor's will of course treat the inflammation, which is usually painful and the person may feel a sharp pain when breathing or less often, like pressure on the chest. Lying down makes it worse. Medications are used and tests are run to make a diagnosis. Other symptoms include swelling in the lower limbs, coughing, being tired and having a fever. This condition may be diagnosed as a heart attack and vice versa. After comforting the patient, the goal is to cure or treat the underlying problem. The cause of pericarditis is not always discovered, however.

Ironically, today was another day for observing differences. In America, one of the most popular or most interviewed medical experts is Sanjay Gupta, a neurosurgeon who is also a reporter for CNN. Oh, you might recognize the name as he was once considered for nomination to US Surgeon General - which he declined. Anyways - I heard the story about Nigeria's ill president on the BBC World News, and they had their own doctor to interview.

He did say that kidney disease could be a cause as could infection, such as TB or tuberculosis. Oh there is another ONE, osis - meaning an increase in something or even an invasion of something, like a parasite. The British physician also noted systemic diseases like rheumatoid arthritis and recent heart attack as possible triggers for this condition. Pericarditis is considered a chronic condition if it lasts more than six months. It can also become more serious if it leads to excess fluid in the pericardium as this pressure on the heart can make surgery necessary.

At last word, the cause of the Nigerian President's case was unknown.

This is a condition that does not appear related to eating too much or exercising too little, or even smoking! However, if a person with this condition is overweight, inactive or smokes, I bet that would be addressed in treatment!

It'll Be Tomorrow

It will have to be tomorrow that I write the blog I had planned for today. I know where I want to take my pontification, but I have not read the article that will be my fodder and the hour is late.

Instead for today, in honor of American Heart Month, I direct you the the American Heart Association's Simple 7. There are seven things that will improve the health of your heart and you can sign up to improve one or more of the areas involved. They include not smoking, eating well, exercising, losing weight, lowering high cholesterol, controlling blood pressure and blood sugar. Click on the link above and get started now.

If you happen to be in Arcadia, Florida tomorrow, please come to Desoto Memorial Hospital to hear me speaking about Smoking and Heart Disease!

Tomorrow - misleading advertisements....

Weekly w/ Video

The News:

The American Heart Association: I hope that this volunteer health agency which is comprised of both medical and non medical volunteers is one that you trust. It has been in existence since 1924 and facilitates research into the prevention and treatment of heart disease. Their mission includes reducing deaths from heart attack and stroke by 25%. Research is published in peer reviewed journals and is used to create evidence based guidelines for health care professionals. The AHA recently spoke to Congress and shared concerns that the gains that have been made in reducing the above mentioned deaths will soon be lost due to increasing numbers of heart disease. A major concern is obesity and the Association is urging the government to increase funding for prevention in the schools and community. They are also very clear regarding the consequences of tobacco use and support FDA regulation of tobacco products which would limit if not prohibit some of the marketing and advertising by tobacco companies. The main risk factors for heart disease include: unhealthy weight, poor diet, smoking, and diabetes (type 2). These are modifiable risk factors, in other words, you can control them.
Carcinogens in Products: I am going to start sounding like a broken record but I cannot help but point out this type of discrepancy when I see it. An American consumer interest group had made claims that some Johnson and Johnson baby shampoo and lotions have two chemicals that are known to cause cancer at some level. They are formaldehyde and 1,4 dioxane. I have not researched this myself I only point out that the organization has gotten the attention of the Chinese government where these products are sold. They are also sold here but the FDA is not yet investigating. There is no report of death or illness at this time. This is of note because cigarette smoke contains at least those two chemicals and over 40 more carcinogens. These “cigarettes” are responsible for millions of deaths a year worldwide… so uh, where is the outrage? [post note: this issue has been cleared by China's state food and drug agency]
Pretending to Smoke: What an odd little “game” the children have created. From A WSJ article I learned that kids can crush up certain candies, sort of inhale the dust and then blow out smoke. They even practice blowing smoke rings. All I am saying, kids really need to get out and play more
PSA Testing: I recall talking about this test for prostate cancer when my newsletter was first being published. In the early 2000s then, the concern was whether to test and then whether to treat because this cancer, though the second cancer killer for men, was a slow killer and often the men could live the rest of their lives without much decline in quality of life and likely die of something else before the cancer killed them. [probably they will die from heart disease, no?]. The testing or screening can lead to biopsies and treatment that is rife with side effects. The treatment can be debilitating and or embarrassing. Two very large research studies, studies lasting 15 years, do not offer a disposition. Over 240,000 men were studied. The results were a very slight benefit in one study, but with significant side effect costs and the other found no benefit at all. This is exactly the kind of reporting I want to see on medical devices, tests and treatments. Not that they do not work, but whether or not they work and what the risk to benefit is.
Number One Cancer Killer?: Good question. Though men suffer from prostate cancer and women from breast, the number one killer of both men and women is lung cancer. There may be a higher prevalence of the other cancers, including colorectal, but those with lung cancer generally die from it, while the other cancers have better survival rates.
HDL: The Good Guy: A reader and friend recently asked me to tell him a way to raise his good cholesterol that he didn’t already know. Certainly he knows what most of you know, you raise it through exercise (though not exponentially) but more often those with high HDL have a gene that promotes it. I did take his challenge however and read what I could about the issue from sources that I consider valid or research based. I.e. you are NOT going to hear me recommend a supplement to increase your HDL. What you will get from me is a practical application of what I have vetted. Here it is then. The mayo clinic among others, notes that oils with mono unsaturated fats, like olive and peanut, enhance the anti-inflammatory properties of the HDL. So though you may not be able to change your number you may be able to increase the impact of that number, in my opinion. I strongly suggest that you follow my example from the cooking demos and do not cook in the oils but add limited amounts to your already cooked veggies or to a salad. A teaspoon for example, or even a tablespoon spread throughout the day. It is also true that HDL works in keeping you healthy by carrying out excess bad cholesterol. It is known that certain fibers can also aid in ridding the body of bad cholesterol so again I recommend something like my cereal bars. Lastly, do not smoke. Smoking lowers HDL. Some research supports that red wine may have an HDL promoting effect but not enough to make a standard recommendation for anyone to add wine if they do not currently drink it.

That will bring us to today’s cooking video. The point of these videos is to assist you in eating food, lots of food really, without adding non nutritive and even disease promoting extras.. like saturated FAT and sugar. Today’s show is peanut butter cookies which in fact, are HIGH in fiber… and the peanut butter is a source of monounsaturated fats. These are not your mother’s PB cookies, nor my mom’s which are fantastic.. but this blog is about health not decadence.

Ingredients include:

Smucker’s All Natural Peanut Butter
(do not use jiff, peter pan, etc- for numerous reasons)
Splenda or Altern
Kellog’s All Bran Original
Loose Oat Bran
WATER
Non fat cook spray (butter)
Cookie Sheets
Large microwaveable bowl… glass is best
Heat oven to 375*
I forgot to say this in the video but cook the cookies for 20 minutes and then check them, move pans around, check every five or ten minutes, you will get the idea in time.

This is the original recipe from a cook book I made a long time ago, but it is hard to explain what I mean, thus the video!

4 Tbls smucker’s all natural peanut butter
water
2 c All Bran original
¼ cup loose oat bran
¼ to ½ c loose Splenda

In microwave if available, heat the peanut butter with about 1 ½ c or more water for about 2 minutes, then use beaters to mix this until it is peanut butter colored water mixture, also mix in the sweetener. Then add the cereals, set aside until moist. Mix this again adding some water until it is moister than other cookie dough. I use a scoop to make two trays with 20 cookies on each. Bake at 375, twenty or so minutes until done. More water and less cooking makes them seem moister. It is good to experiment until you like them!! Made my way, each has about 20 calories.

Serving size: 3 cookies
Amount per serving: calories: 60; fiber: 3g; protein: 2g; fat: 2g.