Tag Archives: heart disease

The diet wars continue

If you are confused or frustrated by the conflicting claims about whether a low-fat or low-carbohydrate diet is the best, you are forgiven. First we were told that eating a low-fat diet was the best way to lose weight and improve heart health. Then, research suggested that low-carbohydrate diets were better. And back and forth it has gone for years.

During this time, the prevailing recommendations have suggested that a diet low in fat and high in carbohydrates was best. But more and more research has supported the notion that cutting carbohydrates, not fat, would lead to greater weight loss. Although this has been supported by some research, critics pointed out that eating more fat would raise blood cholesterol and other risks for heart disease.

According to a recent study, though, low-carbohydrate diets seem to have benefits for promoting weight loss and improving some indicators of heart health over low-fat diets. But you should hold off on shunning fruits and vegetables in favor of cheeseburgers! Here is a practical interpretation of the research and some common sense recommendations, taken from my Health & Fitness column in the Aiken Standard this week.

The study, published last week in the Annals of Internal Medicine, reported on 150 men and women who either restricted the amount of carbohydrates or fat they ate. After one year, the group that ate a low carbohydrate diet lost over 7 pounds more than the subjects on the low-fat diet. Additionally, the low-carbohydrate diet promoted greater improvements in blood lipids than the low-fat diet.

This is important for two reasons. First, this wasn’t a weight loss study; the researchers were simply following the subjects to see what would happen as they followed either diet. The fact that the low-carbohydrate group lost more weight suggests that it is relatively easier to cut calories following this type of diet.

This is consistent with other research showing that eating more carbohydrates, especially refined carbohydrates and sugar, can actually make people feel hungrier and eat more. Indeed, other studies have shown low-carbohydrate diets to be more effective for weight loss than low-fat diets (although a more recent study suggests there isn’t such a difference).

Second, the greater decrease in triglycerides and “bad” LDL cholesterol and increase in “good” HDL cholesterol in the low-carbohydrate group were different from what might be expected. Conventional wisdom holds that a low-fat diet should have a greater effect on blood lipids. Since weight loss can have a big effect on blood lipids, the improvement in the low-carbohydrate group may be due to losing more weight, not a direct effect of the diet.

It is important to note that the low-fat diet also led to weight loss in this and numerous other studies. The critical component of any weight loss diet is that it is relatively low in calories, regardless of what nutrients supply those calories. Really, almost any diet will lead to weight loss as long as it contains less energy than what is expended, but a low-carbohydrate diet may be more effective for weight loss than the traditional low-fat diet.

The bottom line is that the best diet is one that emphasizes eating wholesome foods, not on cutting carbohydrates or fat. That said, limiting carbohydrates in the form of refined grains and added sugar is an excellent way to reduce calorie intake and improve the overall nutritional value of what you eat. And shifting toward more monounsaturated fats (think olive oil and nuts) rather than worrying about the total amount of fat you eat is also a good idea.

To make your diet healthier, add exercise.

The American diet is frequently blamed for the poor health of Americans and, increasingly, other countries. The quest for the healthiest way to eat can literally take people around the world to find the right foods eat.

Unfortunately, diets and supplements that include these “super foods” are rarely the answer to good health on their own. It turns out that the key getting the optimal health benefits from your diet isn’t the food itself—it’s exercise!

This is the topic of my Health & Fitness column in the Aiken Standard this week. It’s not to say that what you eat isn’t important (it is!). The point is that healthy eating will only get you part of the way to the goal of good health.

For decades scientists have tried to isolate the types of foods or individual nutrients that lead to good health by studying what healthy and unhealthy people eat around the world. In some studies eating more of a certain nutrient or food, like saturated fat or red meat, was associated with a higher risk of heart disease and people who ate more fish had better heart health.

This is how we arrived at the common guidelines that encourage us to eat more fish and less red meat. The assumption was that the saturated fat in red meat was the cause of more heart attacks in Americans while the beneficial oils in fish protected the Japanese from heart disease.

But these studies, or at least the interpretation of these studies, didn’t take into account the fact that the populations that had the higher heart attack risk were also less active than their healthier counterparts. Perhaps it was the physical activity that made the difference in health.

A good example of this is the popular Mediterranean diet, which is often touted as the healthiest diet in the world. It’s true that people in the Mediterranean region historically tended to have a lower risk of heart disease. This was thought to be due to their diet which emphasizes healthy fats from olive oil along with vegetables, whole grains, seafood instead of red meat, and red wine in moderation.

Unfortunately, eating more olive oil or drinking more red wine, both recommendations based on the Mediterranean diet, won’t necessarily make you any healthier. This is because health benefits are due to a complex interaction of what we eat and other lifestyle factors, including activity. And people in the Mediterranean region move a lot more than we do, a key to realizing the benefits of the local diet.

Another example is the Ornish diet, a low-fat, semi-vegetarian diet that has been credited with improving blood lipids and even reversing the process that clogs arteries in heart disease. This is part of the reason for the recommendation to avoid foods high in saturated fat and cholesterol and eat more vegetables. It’s true that this diet has been shown to improve heart health, but the subjects in the studies also exercised regularly. Achieving the full benefits of this diet requires exercise, too.

Even the typical American diet won’t necessarily be unhealthy when combined with enough exercise. The Olympic swimmer Michael Phelps famously revealed what he ate on a typically day. The amount and type of foods he consumed were not what you would expect from someone so fit and healthy! Without the hours of training he engaged in each day that diet would almost certainly have resulted in obesity and poor health.

So, as you work toward improving your diet, don’t forget about the importance of daily exercise or other activity in maximizing the health benefits. And when people ask your secret, you can tell them that the real key to a healthy diet is exercise.

Don’t go into (health) debt!

We are all aware of the hazards of being in debt. Too many individuals and families have gotten themselves in a poor financial situation by spending too much and not saving enough. For most, this debt has developed over several years and will have an impact lasting years into the future.

Unfortunately, this is not the only debt we face. Many of us are also in a health debt crisis. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Poor eating habits and increasingly sedentary lifestyles have led to an obesity epidemic. This is important since the three leading causes of death among adults (heart disease, stroke, and cancer) are directly linked to poor diet, inactivity, and obesity.

Obesity, diabetes, heart disease, and cancer are among the conditions that make up our health debt. Even if we have not been diagnosed with these or other health conditions, our lifestyle has put us on that path.

Whether our doctors have told us or not, many of us are in poor health. And our overall health and potential complications get worse each year, so the longer we are overweight and inactive, the worse our health is likely to be in the future. That is our health debt crisis.

Another example of a health debt is smoking, the cause of nearly 90% of lung cancer cases. Lung cancer doesn’t develop after the first cigarette; it takes years of smoking to cause cancer. One estimate suggests that there is a 20 year time lag between smoking and lung cancer diagnosis.

During this time smoking is causing damage to the lungs that leads to cancer, but it is usually undetectable. The cancer process is underway long before it causes symptoms, and since smokers are unaware of it, they continue to smoke. Quitting smoking begins to erase this debt but former smokers suffer poor health even after they quit. In some cases, the debt can’t be completely paid back.

Aside from poor health and reduced quality of life, health debt carries a financial cost. The medical costs attributed to obesity alone are estimated to be $147 billion per year, and a typical obese patient spends over $1,000 more per year on their own medical care than someone at a healthy body weight. The financial burden is both collective and individual, meaning we all pay for it.

Just as financial debt is due to an difference between the money we save and what we spend, much of our health debt is due to an imbalance between the energy (calories) we save and spend.

We have been spending too little energy through activity and saving too much of the energy we eat in the form of fat. Each day we consume more calories than we burn, we store that extra energy as fat. Even a small difference each day adds up over time.

Putting it in these terms, the pathway out of health debt is clear—spend more energy by being more active and cutting back on the calories we eat. Like a financial debt, even though the solution is easy to identify, putting it into place requires making some difficult choices.

But it doesn’t have to be a painful process. Even small changes in activity and diet can lead to weight loss and improved health over time. Make it a priority to be active every day and try to spend less time sitting. Pass on second servings at meals and skip desert once in a while.

Remember, the health debt wasn’t created overnight. It was the result of small changes over time, some of which we may not have noticed. Fixing it will take time, too.

Are fat-free and sugar-free foods healthy? Maybe not!

Have you ever felt confused by the health claims made about some foods? If so, you are not alone. Nutrition is isn’t always easy to understand and, unfortunately, misleading information on food labels only makes it worse.

There are a great many foods that seem as though they would be healthy choices for weight loss or good health in general. Surprisingly, some of these low-fat and low-sugar alternatives aren’t as healthy as you might think.

This is because, in many cases, the claims on the label only tell part of the story. This isn’t to say that the information is false, but it does require some interpretation to understand whether these foods are really a healthy choice.

My Health & Fitness column in the Aiken Standard this week includes two examples of label language that seems to indicate a healthier option, but may not necessarily be the case:

1. Fat-free

Cutting back on fat intake is a good way to reduce calories and is typically recommended for weight loss. It is also a major part of traditional recommendations to lower cholesterol and prevent heart disease, although recent research suggests this may not be so important.

In order to meet a demand for lower fat and lower calorie foods, manufacturers have long offered fat-free versions of popular items. Cookies, snack foods, and salad dressings are among the most popular fat-free foods, especially for people who are trying to lose weight.

However, the number of calories in the fat-free foods may be the same as the full-fat versions because manufacturers often add sugar to make these lower fat foods taste as good. This is often the case for cookies, cakes, and other fat-free baked goods.

In the end, these fat-free foods may not really be lower in calories. And common sense tells us that the best way to reduce calories is to eat fewer of these snack foods and dressings in the first place.

 2. Sugar-free

Reducing sugar intake is also a popular way to limit calories in many foods and beverages. Currently, sugar is viewed as a major contributor to obesity and poor health in general, so this also makes some foods appear to be healthier than they really are.

While it is true that sugar-free versions of desserts and snack foods do usually contain fewer calories, the alternative sweeteners used instead raise some concerns. While there is no good evidence that these sweeteners are harmful, they certainly don’t make these foods any healthier.

It is important to note that the concern is with foods that have added sugar, such as packaged or prepared desserts, baked goods, and snacks. Foods with naturally occurring sugars like fruits, fruit juices, milk, and some vegetables are not worth worrying about.

Again, the most reasonable approach to creating a healthy diet is to eat fewer foods with added sugar, not looking for foods that replace added sugar with artificial sweeteners.

The Bottom Line

The problem for most people isn’t that they are eating cookies with too much sugar or salad dressing with too much fat, it’s that they are eating too many cookies and using too much dressing in the first place. Lowering fat or sugar in these foods does little to make people healthier.

The only way to do that would be to limit the intake of these processed foods in favor of more “real” food. Indeed, fruits, vegetables, nuts, and natural oils (like olive oil) are widely thought to be healthful, certainly better than processed and modified alternatives.

When normal isn’t normal.

The typical American is overweight, doesn’t get enough exercise, eats too few vegetables and fruits, too much sugar, and too many calories. Unfortunately, we have come to consider this combination as “normal.” While this situation may be common, it is definitely not normal. This is the topic of my Health & Fitness column in the Aiken Standard this week.

For most measures of health, a normal value is consistent with good health. A “normal” blood pressure is in a range that is associated with a low risk of stroke, for example. Someone with LDL (bad) cholesterol that is considered “above normal” has a greater risk of heart attack than a person with a normal LDL value.

But for many health indicators, having a normal value is not the norm. According to the most recent recommendations, a normal blood pressure is less than 120/80 mmHg. However, nearly 60% of adults have a blood pressure that is above normal, meaning they have hypertension or prehypertension.

A person who has a body mass index (BMI) in the normal range, between 18.5 and 24.9 kg/m2, is considered to be at a healthy body weight. But two-thirds of adults are overweight, with a BMI above the normal range. Similarly, participating in regular exercise should be considered normal. But it’s not, since fewer than half of adults meet minimum recommendations for physical activity.

The problem is that the term “normal” is frequently used to refer to what is typical, rather than what is healthy. Obesity is so common that a person who is at a healthy weight may look out-of-place. So many people look for ways to avoid physical activity that a person who walks instead of drives is considered abnormal. The person who comes away from a buffet with a less-than-full plate or who has a salad for dinner often gets strange looks. One of the reasons that people get noticed for doing these things is because they stand out from the crowd.

In reality, though, many of the health behaviors we consider to be abnormal—regular exercise, a healthy diet, or a lean physique—are, historically, completely normal. Until relatively recently, most everyone was active much of the day and spent little time being sedentary. Likewise, the consumption of the processed foods that are such a big part of our current diet was rare even a few decades ago.

It is likely that, by considering unhealthy behaviors to be normal, we have created a situation that discourages people from adopting a healthy lifestyle. As anyone who has tried to change their health habits knows, it can be a challenge, especially if everyone else maintains their typical eating and activity pattern. It’s not easy to be “the one” who only eats healthy food or who takes time to exercise every day.

Maybe we need to redefine normal health behaviors to reflect what is healthy rather than what is most common. When walking or biking rather than driving becomes the norm there will be greater incentive to provide safe places for pedestrians and cyclists to travel. When a healthy diet is considered normal it is more likely that restaurants will offer more nutritious options.

In the end, we would all benefit from changing our definition of normal. And a normal diet and activity pattern will go a long way to promoting a normal BMI, blood pressure, and cholesterol.

Reducing your risk of heart disease

February is Heart Month, an ideal time to assess your risk of heart disease and take steps to improve your health. This is important because heart disease, sometimes called coronary artery disease, is the leading cause of death among adults in the United States. It is responsible for nearly 600,000 deaths each year, mostly from heart attacks. Millions more are at increased risk because of certain biological and behavioral risk factors.

Identifying your personal risk for heart disease and making efforts to improve your heart health is the topic of my Health & Fitness column in the Aiken Standard this week.

Some of these risk factors cannot be changed, such as age, sex, and family history, while others can be altered to reduce risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity. While your doctor can play an important role in treating these conditions, there is much you can do on your own to improve your heart health.

The first step is to get a good assessment of your heart health. If you haven’t done so recently, you should see your doctor to have your risk factors evaluated. This includes tests for blood glucose and blood lipids (including total, LDL, and HDL cholesterol and triglycerides), measurement of your blood pressure and body weight, and an assessment of other health factors such as your family history, whether you smoke, and your level of physical activity.

The next step is to treat the risk factors that you have. Depending on the severity and your own personal health history your doctor may prescribe medications to lower your blood pressure, blood glucose, or blood lipids. These medications are most effective when combined with lifestyle changes including good nutrition, exercise, and weight loss. In some cases, poor diet and lack of activity can counteract the beneficial effects of these drugs. Furthermore, these healthy habits may help you reduce the dosage, and limiting the side effects, or stop taking the medications altogether.

The other risk factors—obesity, inactivity, and smoking—really must be treated through lifestyle management. While there are medications that can help with smoking cessation and weight loss, being successful requires making lasting behavior changes. These habits can be difficult to change, and many people have tried before without success. Keep in mind, though, that everyone who is successful at quitting smoking, losing weight, or sticking to an exercise program has experienced his or her share of difficulty. The difference is that those people kept trying until they were successful. You can be successful, too.

Even small changes can have a big impact. Take exercise, for example. The benefits of as little as 30 minutes of physical activity per day are well established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, which can have such a broad impact on reducing heart disease risk!

Of course, there are steps you can take beyond becoming more physically active to reduce your risk of heart disease. The list of beneficial changes you can make to improve your heart health is long, but keep in mind that even small changes can add up to a big benefit. 

Knowing which risk factors are most concerning can help you and your doctor make effective treatment decisions. Quitting smoking, increasing your physical activity (and reducing sedentary time), and eating a healthier diet can lead to improvements in heart disease risk factors and reduced heart attack risk. The best news is that these same changes can also reduce your risk of other serious health problems including many types of cancer, stroke, and lung disease.

 

 

Go Nuts (again)!

My Health & Fitness column in the Aiken Standard this week is about the health benefits of nuts. It is  a follow-up to a blog post I wrote a few weeks ago. This isn’t new, of course, since nut consumption has been recommended as a part of a healthy diet for years.

What is new is a recent study in the New England Journal of Medicine that shows that nut consumption was associated with a reduced risk of death from heart disease, stroke, and some cancers. The people who ate nuts every day got the biggest benefits.

That doesn’t mean that simply adding nuts to an unhealthy lifestyle will have some magical influence on health. In fact, the people in the study who ate the most nuts were also likely to do other healthy things like eat more fruits and vegetables, exercise, and not smoke.

The most practical advice is to eat nuts as a replacement for other snacks or to add nuts to salads and other dishes. While specific types of nuts have different health benefits, the recent study suggests that all nuts, including peanuts, are beneficial.

Go Nuts!

A new study suggests that going nuts is good for your health. Published in the New England Journal of Medicine this week, the study shows that regular nut consumption is associated with a lower risk of death from many leading causes of death, including heart disease and cancer. (If you aren’t motivated to read a journal article, this video will give you the key points from the study.)

The reduction of risk was greater with more frequent nut consumption. For example, the risk of death from all causes was 11% lower among men and women who consumed nuts once per week and 20% lower among those who consumed nuts seven or more times per week. 

This is level of nut consumption could be met by a common recommendation to consume 1–1.5 ounces of nuts as a snack every day.

One thing to keep in mind is that the health benefits of nut consumption might be due to other positive lifestyle factors that go along with greater nut consumption. Indeed, the authors noted that, “As compared with participants who consumed nuts less frequently, those who consumed nuts more frequently were leaner, less likely to smoke, more likely to exercise, and more likely to use multi-vitamin supplements; they also consumed more fruits and vegetables and drank more alcohol.” Although these other factors were controlled for in the study, common sense suggests that the reduction in risk is due to a combination of beneficial health behaviors.

This is an important point. A person who eats in unhealthy diet, is sedentary, and smokes is unlikely to realize the  health benefits of increasing nut consumption. Achieving the full benefits of nut consumption also certainly means adopting other healthy behaviors.

This is good news! Eating more nuts is a relatively easy dietary change to make. And as this study shows, it can lead to a reduced risk of death from some common diseases. So…go nuts!

When fat attacks! And how to win the battle.

My Health & Fitness column in the Aiken Standard this week is about fat. It turns out that fat is far more than just a place to store extra calories. Fat has metabolic and physiological effects that can promote disease, including diabetes and heart disease. And that is how your fat can attack you.

But regular exercise can offset or reverse many of the negative effects of excess fat. This is why people who are “fat but fit” may fare better than people who have a normal body weight, but don’t exercise.

If you want to learn more about the role of adipose tissue on health, these are two articles are a good place to start (fair warning–they are high-sci):

George Ntaios, Nikolaos K. Gatselis, Konstantinos Makaritsis, George N. Dalekos. Adipokines as mediators of endothelial function and atherosclerosis. Atherosclerosis 2013;227(2): 216-221. http://dx.doi.org/10.1016/j.atherosclerosis.2012.12.029

Coelho M, Oliveira T, Fernandes R. Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci. 2013;9(2):191-200. http://dx.doi.org/10.5114/aoms.2013.33181