Monthly Archives: September 2006

Proof! Reduce Your Risk of a Heart Attack by 87%

Proof!  Reduce Your Risk of a Heart Attack by 87%

Competency # 20 – “The Lifestyle(Cuisine) of the Long-Lived”

Reference: Circulation:  July 11th, 2006

This is big!  We should be singing this from the rooftops.  Half of all Americans die from coronary artery disease.   Each and every one of us should be looking for the  methods and combinations of behaviors to prevent that risk.  Now we have the methods.  The proof is in.  Published this last month in the Journal Circulation are the results of 16 years of longitudinal research on 43,000 health professionals (Unfortunately, all men.  Bet it works for women too but the “proof” isn’t there yet).  This research out of Harvard should be our aggregated guidelines for each of us.  Here is the “skinny” on the combination that works.

Strategy 1.  Literally.  The skinny.  A body mass index below 25.  Keeping your weight in control has a very powerful effect that can’t be denied.  (Calculate BMI by taking your weight in pounds, divided by your height in inches, divided again by your height in inches, multiply by 703 = BMI).  Readers of this column know from our reporting last fall that we now know that your waist to hip ratio is 2.8 times as accurate in predicting future heart desease.   That is not what was followed in this landmark study.  Your waist to hip ratio should be < .9 for men and less than .85 for women.

Strategy 2.  Not smoking.  (Whew, a freebie for many of us).  That’s how important that one is for those who do.  Yes, it’s that dangerous.

Strategy 3.  Exercise.  (Ouch.  As painful as the last one was easy).  “ A day without exercise is as bad as a day of smoking”.   The study said: 30 minutes each and every day.  Walk, stretch, lift, sweat, park far, take stairs.  30 minutes.  Plain and simple.  That’s what works.  Just do it.

Strategy 4.  Alcohol.  1-2 drink a day.  Here the risks are clear.  We didn’t say it was a 24 oz glass of Scotch.  If alcoholism is in your family, the risks might weigh against this one.  And for women, there may be some added risk in other venues.  For men, 1-2 drinks a day, tops.

Strategy 5.  Eat healthily.  Reduce trans fats and saturated fats.  That’s the summary message about eating from this study that started 16 years ago.  That’s pretty simple and we’ve known that saturated fats are wicked.  You have heard me rail against trans fats many times. There are pieces of evidence taken singly that suggest we can add details to this to make the admonition of healthy eating more precise and effective.  Here is my list of what I’m doing for me.  The Sinai Wellness Institute’s “Best Strategies for a Healthy Diet”

a.  Adding olive oil to my diet in place of other oils (more salads).

b.  We have clear proof that fish oil daily reduces sudden death. (Fish or pills)   Getting more omega threes back in and eating fewer omega sixes.

c.  There are also additional benefits from increasing fiber.  30 grams a day is a great start.  40 grams and even bigger changes happen.

d.  Reducing refined grains.  Eat whole grains.  Chunks.  You have to see them.

e.  Adding potassium to your diet in the form of the DASH diet with its 8 servings a day of fruits and veggies is a known winner, and recent studies have even shown that adding potassium in the form of potassium based salt substitute is a winner.  And dump the sodium.  Every way you can.

f.  Antioxidants are a whole new world opening up.  Stay tuned.

g.  Sugar’s gotta go.  Find every way you can to cut down on it.  We’ll cover more on this later.  Most of it is in sugared soda.  Start there.

WWW:  What will work for me.  These five strategies are going to become part of my teaching and thinking to each and every patient I see going forward.  This is how we will make progress in our number one killer, heart disease.  No kidding.  87% reduction.  It’s how we will all practice prevention.  Hurray.  We’ve got the proof.

The Bugs in Your Guts Can Make you Fat: A Whole New Field of Research

The Bugs in Your Guts Can Make you Fat: A Whole New Field of Research

Competency # 1 Know Thyself

Reference: Int J Obes (Lond). 2005 Mar;29(3):281-6

Once upon a time we said that you gained weight when you ate too much.  Energy in and out had to be equal.  Fair enough.  A calorie was a calorie.  Simple physics.  Then we found out that there were some genes that made some people more efficient at energy utilization. It turned out that the old formulas of how many calories you might need just weren’t right all the time.  We’ve now found about 50 genes that are involved with how we lay down extra fuel as fat instead of burning it as energy.  But conundrums still arose.  There continue to be cases of identical twins that weighed markedly different amounts.

How to explain that?  Same genes?  Now we are beginning to learn and this is fascinating stuff.  Infectobiology, two lines of enquiry around the same idea.  The “germs” that we are “infected” with can have dramatic effects on our bodies that make our metabolisms efficient or not.

First, the bacteria in your gut.  Recent research with germ free mice have shown that absolutely germ free baby mice grow up skinny and can’t gain weight until their guts get populated with the proper gut bacteria.  The bacteria you have in your intestine turn out to do several profoundly important things.  One of those bacteria called B. theta suppresses a protein called FIAF.  FIAF prevents you from storing fat.  The more you suppress FIAF, the easier to lay down fat.  Then there is the balance of Bacteroidetes to Firmicutes, the two main families of bacteria in your gut.  Turns out that if mice guts have more B than F, they are skinny.  But if they have more F than B, they are fat.   In humans at obesity clincs, stool samples of obese patients show the same trends.

Then, there’s the adenovirus.  It often causes nasty sore throats, pink eye and some tummy virus, but one subtype infects and kills chickens.  When the chicken die, they have all sorts of fat in their abdomens, low cholesterol and low triglycerides.  Now, we humans get higher cholesterol and triglycerides as we get fatter so the chickens made for an interesting study.  It turns out other strains of adenovirus infected other mammals and all of them got fat compared to uninfected animals.  It’s considered unethical to infect humans to see if we can make them fat with a virus so we can only look with antibodies to see if populations have been infected.  Guess what happens when Dr. Atkinson and Dhurandhar from the University of Madison surveyed the blood of several hundred obese Wisconsin and Florida residents?  You’re right.  The obese volunteers showed a much higher rate of infection with adenovirus.  And for being overweight, they had lower cholesterol and triglycerides.

WWW.  What Will Work for Me?  What does this all mean?  Of course a calorie is a calorie.  And each of us have to discover our own balance between what we eat and how much what we eat turns into fat.  That remains true.  And some of us have genes that are more efficient than others.  But we are now learning that the picture is much more complex.  It isn’t a level playing field.  Some of us have a balance of bacteria in our guts that make it easy to gain weight, compared to others.  Some of us may have been infected with a virus that changes the efficiency with which we store energy as fat.  Figuring out how these two ideas work and how we can manipulate them to our benefit will be a very interesting story.  It’s obviously a story at the very first chapter.  But if you feel like you can’t eat one calorie extra without gaining weight, you might, in fact be right.  If this were the ice age and your survival depended on having a very efficient metabolism, you’d be in a great spot.  In America in 2006, you really do have to be vigilant.

Chili: Another Spicy Food to Help Control Your Metabolism

Chili: Another Spicy Food to Help Control Your Metabolism

Competency # 5  The Way to Eat

Reference: American Journal of Clinical Nutrition in July, 2006

“HOT” off the presses.  Chilies turn out to be another winning spice.  We have talked about how turmeric might be key to preserving your brain and preventing Alzheimer’s.  Cinnamon, garlic, and ginger all have their own claims to fame.  Now you can add Chilies.  Hurray.  Being a chili-head and having secretly smuggled in Tabasco sauce to restaurants for years, I can now proceed with impunity.  All of us spicy food lovers can celebrate and get down to business of openly putting a shaker of chili sauce right there next to the salt and pepper on your dining room table.

Here are the facts.  In the American Journal of Clinical Nutrition in July, 2006 is a wonderful little study from Australia where chilies were added to a bland diet.  The study design started with measuring how the study participants did for four weeks without any spicy food.  Then, they did a randomized crossover study in which they added chilies to their diet, either in the form of a chili at the end of a meal, or of a meal containing chili.  They measured glucose, insulin levels, C-peptide (looking for systemic inflammation).  What they found was a remarkable reduction in the amount of insulin it took to control your blood sugar.  And the bigger their subjects were, the better it worked.  There is a working theory that our refined “bland” diet wears out our pancreas glands and we lose the ability to secrete enough insulin.  All of our white foods (bread, potatoes, rice, pasta) are forms of glucose in long strings we call carbohydrates: and all require insulin to control their metabolism.  That leads to a gradual rise in glucose in our blood, and that turns into diabetes and all the destruction diabetes causes on our blood vessels in the form of heart attacks and strokes.  Any strategy to control our sugar in our blood with a little less insulin release will add to our long term well being.

The mechanism of how this worked wasn’t studied in this research.  (There was not an increase in energy expenditure or, as my spouse would claim: running around flapping your arms looking for water.) But here is another “spice” that is brightly colored.  It appears that capsaicin must have an effect heretofore unknown.  But the effect was clear.  Adding a chili to your meal lowers the amount of insulin your body has to put out to control your sugar.  More on this story to come.  No other food does this so a whole new arena for study and research opens up.

What Will Work for Me?  I still can’t add Tabasco  “until I taste it”.  And I’m trying to try other forms of chili that don’t have as much salt in them.  I enjoy spicy food.  Maybe I’ll order the medium spicy Thai curry instead of the bland next time.  This appears to be another of the spices that have a great effect on our metabolism that we can all enjoy.  After all, getting lucky over age 50 means someone else cooks your dinner.  So maybe you can still add spice to your life and enjoy health benefits from it as well.

Trans Fats: A Modern Day Poison we Eat with Enthusiastic Abandon

Trans Fats: A Modern Day Poison we Eat with Enthusiastic Abandon

Competency # 13 Fats

Reference:  NEJM April 13th 2006

A poison?  “Them’s fightin’ words.” But they are true.  Here’s why.  Denmark has now banned trans fats from their food supply.   Canada is currently considering a ban and the New York Department of Public Health has asked all the restaurants of New York City to figure how how to ban them.  That’s strong action.   And few of us understand why.

What are trans fats and why are they bad.  Trans fats are “partially hydrogenated vegetable oil.”   To make a trans fat, you take a regularly unsaturated fatty acid, heat it a little with a catalyst and it turns into a more compact, more stable molecule.  Presto, chango, it’s more stable at room temperature.  Crisco is a trans fat product.  It has a delicious creamy quality.  It allows French fries to remain crispy.  It keeps chocolate firm at room temperature and melt nice and slowly when you eat that nice chunk of chocolate.  It makes pie crust yummy.  You can tell, I love trans fats.  We all do.  The food industry does too.  They never spoil because no bacteria can digest them.  So McDonald’s never has to change its vegetable oil.  But if no biological system can digest them, why are we surprised when we find that they aren’t so good for us?  It’s a $ 30 billion industry and 3-5% of our calories.

Here is how they are not good.  The New England Journal of Medicine just published a review article on the topic.

1. Trans fats INSTANTLY raise your LDL and lower your HDLs

2. Increase the ratio of total cholesterol to HDL (strong predictor of vascular disease)

3. Raise triglycerides (again: bad for you)

4. Increase Lp(a) lipoprotein (another bad marker)

5. Inflammatory markers go up:  Tumor Necrosis Factor, Interleukin 6, C Reactive protein all increase  –  Many modern illnesses correlate with higher inflammatory markers.  Those names should be enough to scare all of us.

6. Endothelial cells dysfunction (lining of blood vessels) – up to a 29% reduction on the ability of blood vessels to dilate and stretch

7. Plasminogen activity reduction (Your bodies own clot buster – busted)

8. The list goes on as research is discovering the molecular mechanisms. I’ll stop.

9. Summary:  Trans fats are TWICE as bad as saturated animal fats.

We eat about 3 % of our calories in the form of trans fats.  More if we eat out a lot in restaurants.  A 2% reduction or increase in trans fat consumption is predicted to have about a 23% change in your risk for vascular disease.  That means avoiding trans fats is about one of the most potent things you can do to protect your health.  In a society where 50% of us will die of vascular disease, this should be a first priority.

You’ll find trans fats in: cookies, donuts, French fries, pie crusts, breaded coatings of fish or chicken, tortillas, pancakes, peanut butter, burritos, fried chicken.  Almost all fast food that’s fried is fried in trans fats.  Unless you live in Denmark… We take statin pills to lower our cholesterol and lower our inflammatory markers.  And then we eat trans fats so that we need our pills.  Make sense to you?  It’s time to learn to read the food label.

What Will Work for Me:  This is a painful journey.  But one that has to start.  I’m off fries, most of the time.  And I’m eating less chocolate.  We threw out the can of Crisco and cook mostly with olive oil.  I order grilled items in the restaurant more, and soup more.  But pie, Oh dear, I guess I’m still at 2%.  If  I can drop down to 1%, it’s another 12% reduction in my heart disease risk.  I can’t stand losing any more friends from heart disease.  So do it.  Read the label.