Losing weight without developing gallstones

Gallstones are estimated to affect 1 in 10 people in North America. Those who are obese have a higher likelihood of developing gallstones. Most at risk of gallstones as a result of obesity are Native Americans, the elderly, and Caucasian women in their forties who haven’t yet reached menopause.

Gallstones are so named because they develop in the gallbladder, a small organ that stores and releases the bile made by the liver. Bile is a dark green fluid containing bile salts and cholesterol. The gallbladder releases bile into the small intestine to assist in digesting fats more efficiently. However, if the bile contains high concentrations of cholesterol, then stones too difficult for the bile salts to dissolve may develop.

Because gallstones usually form without any symptoms, most people don’t know they have them or may feel only minor symptoms such as abdominal pain after eating a fatty meal. However, if a stone becomes lodged in a bile duct causing blockage, it can result in sudden pain in the abdomen, back or right shoulder.

Cholecystitis, or gallbladder disease, which is caused by duct blockage, infection or inflammation, is one of the most common digestive diseases. Pain from duct blockage can become intense and lead to hospitalization and surgery. In the U.S. alone, gallbladder surgeries approach 700,000 annually, costing approximately $6.5 million.

Surgery costs increase if gallstones and duct blockage or infection cause the pancreas to become inflamed. The resulting pancreatitis can lead to severe or life-threatening complications. The major cause of acute pancreatitis in North America is gallstones.

Link to Obesity and Losing Weight Too Quickly

Because of obesity’s major role in the formation of gallstones, weight management is critical for decreasing the likelihood of developing them. Obesity is thought to increase risk of gallstones because of elevated production of cholesterol, which in turn increases the concentration of cholesterol in bile.

Paradoxically, losing weight actually increases risk of developing gallstones among obese people, especially amongst those who lose large amounts of weight rapidly. Although not entirely understood, nutritional and medical scientists think that losing weight too quickly may shift the balance of bile salts and cholesterol, causing increased concentrations of cholesterol. Gallstone risk may also be increased by consuming a diet too low in fat or avoiding fat, which reduces the frequency of gallbladder contractions and results in fewer chances of gallbladder emptying.

As always, individuals with a high risk for gallstones should follow medical advice in treatment. Medical researchers have studied methods that obese people can lose weight while reducing risk of gallstone developments. Statin regimens and bile salt therapies have had mixed results. A drug called ursodiol has shown much promise in helping to dissolve cholesterol in bile and prevent gallstones.

There have also been successes such as employing modifications in diet to help reduce risk of gallstones. Along with following a doctor’s advice, individuals can consider these weight-management strategies, which have shown promise based on epidemiologic studies or in clinical trials for losing weight as naturally and safely as possible.

Three Steps to Help Lower Risk of Gallstones While Losing Weight

Step 1: Avoid very low-calorie dieting, losing no more than 1-2 pounds per week.

Overall, research studies have found that obese people who lost 3 pounds or more weekly had a greater likelihood of developing gallstones. This may be because they are more likely to experience an imbalance between bile salts and cholesterol, as well as irregular gallbladder emptying.

For these reasons, people who are obese or who are at high risk for developing gallstones should also avoid skipping meals or fasting.

By eating three steady meals throughout the day and losing weight at a slower rate, obese people can reduce the weight-loss risk factor in gallstone formation. To ensure steady weight loss at 1-2 pounds per week, calorie intake should be reduced by only 500 to 1,000 calories. Weight loss is also influenced by activity, which may require eating more calories to compensate for calories burned.

Step 2: Avoid saturated fats and eat small amounts of monounsaturated or polyunsaturated dietary fat daily.

Foods high in saturated fats, trans fats and cholesterol are all associated with increased risk in gallstone formation. However, foods high in polyunsaturated or monounsaturated fats (from olive oil or high-oleic sunflower oil) may help lower cholesterol saturation and reduce risk of gallstone formation.

A randomized clinical trial on obese subjects compared a low-calorie diet (900 kcal/d) with 30 grams of fat per day with a low-calorie diet (520 kcal/d) with less than 2 grams of fat per day. After eight weeks, not one of the subjects on the diet with 30 grams of fat per day had developed gallstones. The researchers were led to conclude that dietary fat ensured regular gallbladder emptying and reduced bile cholesterol saturation.

A 10g threshold of fat per meal is now considered to be most efficient at maximizing gallbladder emptying, which can support healthy weight loss while reducing risk of formation of gallstones.

Furthermore, according to one randomized, double-blind, placebo-controlled clinical trial, fish oil in amounts of almost 12 grams per day may work comparatively to ursodiol in reducing risk of gallstone formation in low calorie diets.

Step 3: Avoid refined sugar and strive for a diet high in fiber.

In epidemiologic studies, there is a higher association of gallstones in those who ate greater amounts of refined sugars. In contrast, long-term consumption of relatively high amounts of dietary fiber has been correlated with reduced risk of gallstone diseases.

The risk appears to be even lower if the amount of fiber consumed comes from sources rich in insoluble fiber found in whole grains, fruits and vegetables. Soluble dietary fiber such as found in oats and legumes also appears to be protective, showing reduction of gallstone formation in animal studies.

Diets higher in fiber and lower in refined sugars will also assist in weight loss. Refined sugars, found in high amounts in sodas and desserts, contribute to high calorie intake, which contributes to obesity. Dietary fiber is filling, providing a satiety effect, but offers little or no calories that would contribute to weight gain.

Individuals should increase dietary fiber to recommended levels (25 to 30 grams daily) gradually.

Safe Road to Optimal Health

Once again, each of these steps is a natural dietary habit that will help lower the risk of developing gallstones and support losing weight safely. Apart from diet, getting regular exercise daily is also helpful. And, for every pound lost gradually, the ultimate achievement is reduced risk of gallstones in the future.

Beyond reduced risk of gallstones, the end-benefits of healthy weight management are profound including improved activity and mobility, improved health of organs such as the heart and brain, and reduced risk of diseases such as type 2 diabetes and cardiovascular disease. Healthy weight management improves overall health and wellness at every level.

Nutrition and Breast Cancer

Thanks to recent research in nutrition, dietary strategies are helping many more women survive breast cancer and go on to live long, healthy lives. 

Often enough, evidence reveals these strategies may work by influencing inflammation, the immune system, and insulin responsiveness. However, there is no nutritional therapy that is yet "proven" to treat cancer directly or increase survival.

According to large trials of diet and breast cancer such as the Women's Healthy Eating and Living (WHEL) randomized trial and the Women's Intervention Nutrition Study (WINS) trial, as well as small intervention studies, a lower calorie diet leading to controlled weight reduced mortality. 

The reason - being overweight or obese appears to increase mortality because of higher risk of metastasis. Crash dieting is not the key, only healthy weight loss and patients should consult a nutritionist for planning meals. 

Patients should note that diets too low in calories can lead to loss of muscle mass, which is already a side effect of chemotherapy, and that generally leads to an increase in fat mass. 

As far as types of foods, red meat should be avoided because it's associated with increased risk of breast cancer. Saturated fat should be avoided as much as possible since it increases estrogenic stimulation of breast cancer growth. 

A low-fat, high-fiber diet is associated with suppressed estradiol levels. The diet should be based on plenty of plant-based proteins (soy, wheat), eggs, fish and low-fat dairy (whey). 

High-carb diets are also associated with increased mortality, but so are very low-cab diets. The diet should focus on obtaining a moderate amount of complex carbs (mainly from whole grains, fruits, and vegetables) rich in fiber. Blood sugar control is encouraged through eating complex carbs and obtaining regular exercise. 

Patients should seek to obtain higher levels of long-chain omega-3 fatty acids (DHA and EPA) such as from fish oil because low levels are associated with more proinflammatory markers. 

Because high dietary intake of fruits and vegetables are associated with greater breast cancer survival, it's easy to suggest that taking supplements of phytochemicals may increase survival. However, meta-analyses suggest no single vitamin/phytochemical solely improves outcomes. Instead it's best to focus on consuming more of whole fruits and vegetables.

Phytoestrogens such as from soy (isoflavones) and flax may, in fact, lower risk of breast cancer and improve survival of breast cancer. Because they mimic estrogen and bind to estrogen receptors, they may inhibit cancer cell growth. However, more research is needed before suggesting as a treatment especially in high-risk women and postmenopausal estrogen-receptive positive breast cancer patients.  Note that it could be that simply replacing meats with soy foods leads to weight management that increases breast cancer survival.

Eating foods rich in iodine such as sea vegetables or using iodized salt may anticarcinogenic effect possibly by optimizing thyroid function. Additionally, maintaining a high vitamin D status may help reduce risk cancer and improve prognosis although more research is needed to understand the relationship.  

Reference 

Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.

Briefly on Detoxification Systems

Every day we are exposed to toxins, or xenobiotics, that are found in our food, water and environment. The body also makes toxins within itself. These all must be either stored such as in muscle or fat or they are  detoxified and eliminated via the feces or urine.

The body's main detoxification organ is the liver, but can also happen in the intestine and other organs. The detoxification systems handle a wide range of compounds mainly by two steps: phase I and phase II detoxification. 

Phase I detoxification is a reaction that entails functionalization of the compound, breaking it down. The major P450 enzymes are generally involved in phase I detoxification. Most major drugs and exogenous toxins are metabolized this way. At times the product of phase I detoxification can be more harmful than the original product.  

Phase II detoxification is a second reaction that generally follows phase I detoxification. It entails transforming a phase I reactant through conjugation (typically to an amino acid, such as in glucuronidation or sulfation) to become water soluble. When it's water-soluble, the toxin can be excreted in the urine. 

Although the phases of detoxification are not yet well understood, it is clear through observational studies that there are a variety of factors that can inhibit or induce detoxification. An inducer of detoxification can be a a toxin itself or a compound in the diet. 

In a typical detoxification support plan, a nutritionist may suggest various nutrients to support or upregulate phase I cytochrome P450 enzymes and phase II conjugation pathways. 

The plan would generally seek to increase glutathione levels in the body such as with n-acetyl cysteine or cysteine or spare glutathione such as with silymarin. 

The plan may also support detoxification in other ways by increasing antioxidant status with coenzyme Q10, vitamin A, vitamin C, or selenium. Or, it may provide B vitamins to act as co-factors for enzymes.  

Reference

http://www.thorne.com/altmedrev/.fulltext/3/3/187.pdf 

62-yr-old Woman with Hypertention, Ventricular Hypertrophy and Congestive Heart Failure

One of the considerations with congestive heart failure is the need for fluid restriction and the patient will need to work her doctor to be able understand how much she should be getting daily.

Sodium restriction is important for bringing down the blood pressure. In the case of this woman, I would employ a DASH diet to bring down her blood pressure with emphasis on plenty of fruits and vegetables as well as dairy products such as yogurt to obtain regular amounts of calcium.
Since being overweight contributes to higher blood pressure, if she is overweight, then the DASH diet should be combined with a weight loss program by restriction of calories.

Regular aerobic exercise can also support healthy blood pressure levels. I'd recommend about 30 minutes three times weekly.

Because of her condition, I'd also recommend supplementation with CoQ10 to support the function of the heart. If she has a low vitamin D status, which is associated with higher blood pressure, then I'd also recommend a vitamin D supplement.

Gallstone Development

Gallstones develop in the gallbladder, a small organ that stores and releases the bile made by the liver. Bile is a dark green fluid containing bile salts and cholesterol. The gallbladder releases bile into the small intestine to assist in digesting fats more efficiently. However, if the bile is contains high concentrations of cholesterol, then stones too difficult for the bile salts to dissolve may develop (1).
Losing weight too quickly or fasting can cause development of gallstones. The quick weight loss and fasting is thought to disturb the balance of bile salts and cholesterol (2;3).

The risk may increase if consuming a diet too low in fat. Avoiding fat reduces frequency of gallbladder emptying. This, in turn, may cause cholesterol to accumulate and lead to greater risk of forming stones (3;4).

References

1. Dowling RH. Review: pathogenesis of gallstones. Aliment Pharmacol Ther 2000;14 Suppl 2:39-47.

2. Wudel LJ, Jr., Wright JK, Debelak JP, Allos TM, Shyr Y, Chapman WC. Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res 2002;102:50-6.

3. Festi D, Colecchia A, Orsini M et al. Gallbladder motility and gallstone formation in obese patients following very low calorie diets. Use it (fat) to lose it (well). Int J Obes Relat Metab Disord 1998;22:592-600.

4. Vezina WC, Grace DM, Hutton LC et al. Similarity in gallstone formation from 900 kcal/day diets containing 16 g vs 30 g of daily fat: evidence that fat restriction is not the main culprit of cholelithiasis during rapid weight reduction. Dig Dis Sci 1998;43:554-61.

Homocysteinemia and Pernicious anemia

Pernicious anemia, a megaloblastic anemia caused by B12 deficiency, is associated with hyperhomocysteinemia. Because B12 is needed for methionine synthase to methylate homocysteine to methionine, a deficiency causes an accumulation of both homocysteine and methylmalonic acid (1). When both are elevated, marking the pernicious anemia, it can lead to progressive demyelination and neurological deterioration.
A folate deficiency may also result in megaloblastic anemia. If homocysteine is elevated but not methylmalonic acid, then the result is probably a folate deficiency. It is important for treatment to be correct. Large doses of folate can correct, or "mask," symptoms of pernicious anemia, which can result in irreversible neuropathy (2).
References

1. Devlin TM. Textbook of Biochemistry with Clinical Correlations. Philadelphia: Wiley-Liss, 2002

2. Pagana, K.D., Pagana, T.J. Mostby's Manual of Diagnostic and Laboratory Tests, 3rd ed. Mosby Elsvier, 2006

Before Taking a Statin, Read This

I thought this was an interesting article from Businessweek a couple of years ago and was blown away by the numbers showing that few people actually receive any benefit from statins.

If you don't read it, then here are a few tidbits from the article that I thought would give it to you in a nutshell:

• ...for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit.
• ...an estimated 10% to 15% of statin users suffer side effects, including muscle pain, cognitive impairments, and sexual dysfunction
• "There's a tendency to assume drugs work really well, but people would be surprised by the actual magnitude of the benefits,"
• For anyone worried about heart disease, the first step should always be a better diet and increased physical activity. Do that, and "we would cut the number of people at risk so dramatically" that far fewer drugs would be needed...
• "The way our health-care system runs, it is not based on data, it is based on what makes money."  

It's amazing how much industry and their marketing overstate claims and directly affect the beliefs of people in these drugs. This kind of influence in our healthcare system desperately needs to be fixed.

Predicting a Heart Attack with CRP

Currently, the existing biomarkers for a cardiac event include B-type natriuretic peptide, tro-ponins and C-reactive protein. C-reactive protein is an acute-phase protein released in response to inflammation.

Recently, the development of a high-sensitivity assay for CRP (hs-CRP) has been made available. The assay works because it can accurately reflect even low levels of CRP. There have been quite a few prospective studies that have shown that an assay of a baseline CRP can be used as a marker for cardiovascular events.

When patients have a test that shows elevated levels, it is even a better marker than LDL cholesterol for predicting events such as myocardial infarction. An elevated test, however, can also mean hypertension, metabolic syndrome or diabetes, or a chronic infection.

In addition, Lipoprotein (a), or Lp(a), when combined with C-reactive protein, can increase the predictive value of a cardiac event. This is especially true for those who have normal cholesterol levels. The reason is that the lipoprotein promotes vascular inflammation that affects the atherogenic process directly.

Reference

Pagana, K.D., Pagana, T.J. Mosby's Manual of Diagnostic and Laboratory Tests, 3rd ed. Mosby Elsvier, 2006.

How to Rid Yourself of Statin-induced Muscle Pain

When a patient is on a statin, nutritionists should advise that they don’t have to suffer from the side effects of statin-associated muscle pain (myalgia). Studies are showing that supplementation with two key compounds are useful for decreasing the pain. The first is ubiquinone (coenzyme Q10, coQ10) and the other is cholecalciferol (vitamin D3).

Statins such as Lipitor, Zocor and Mevacor reduce cholesterol synthesis by directly inhibiting the enzyme HMG-CoA reductase and deplete production of its product, mevalonate (1). Mevalonite, however, is also the precursor to coQ10 and squalene. Both of these are vital nutrients with profound effects on the body.

CoQ10

CoQ10 is a lipid-soluble antioxidant playing a protective effect in the membranes of every cell in the body. In that capacity, it serves to protect against oxidative damage to cells. Equally important, the compound is necessary for electron transfer in the mitochondrial electron transport chain for producing energy (2). Without it, our muscles could not function in their full capacity.
Supplementation with coQ10 combined with statin treatment helps reduce muscle pain (not to mention improve energy levels). According to a double-blind study in 2007 at Stony Brook University, which compared coQ10 supplementation (100mg/d) with vitamin E (400 IU/d), showed that patients taking the coQ10 had 40 percent decrease in the severity of their pain (3).

Vitamin D

Squalene is important because it is the precursor for 25 hydroxyvitamin D (25(OH)D) as well as other steroid hormones. For this reason that, it is suggested that statin drugs can lead to 25(OH)D insufficiency or deficiency. Vitamin D is not only critical for speeding up calcium absorption for bone health, but emerging studies are finding that it’s also vital for the health of muscles (4).
Low vitamin D levels are also associated with statin-induced muscle pain. When researchers from the Cholesterol Center at the Jewish Hospital in Cincinnatti in Ohio treated myalgia in 38 statin-treated patients with vitamin D (50,000 IU/week for 12 weeks), 35 of the patients experienced 92 percent reduction in pain symptoms (5).

Reducing muscle pain with supplementation

If you must take a statin, then supplementation can be to your advantage. As in the studies, supplementation with coQ10 at 100 mg in an absorbable form can potentially help to keep pain under control by replenishing coQ10 that is lost. In addition, keeping 25(OH)D to levels in the plasma to “sufficient” amounts (32 ng/mL) through supplementation with vitamin D and sensible sun exposure can go far to reduce pain.

Reference List

1. Scharnagl H, Marz W. New lipid-lowering agents acting on LDL receptors. Curr Top Med Chem 2005;5:233-42.
2. Jeya M, Moon HJ, Lee JL, Kim IW, Lee JK. Current state of coenzyme Q(10) production and its applications. Appl Microbiol Biotechnol 2010;85:1653-63.
3. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007;99:1409-12.
4. Visvanathan R, Chapman I. Preventing sarcopaenia in older people. Maturitas 2010.
5. Ahmed W, Khan N, Glueck CJ et al. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res 2009;153:11-6.

How a Patient May Avoid An Angioplasty

Angioplasty is a procedure performed by inserting a catheter with a deflated balloon into an affected artery, then inflated to open the artery. Sometimes a stent, or mesh tube, is left to keep it open. The procedure does come with some risk, in fact, having the potential of inducing a heart attack.

If a patient is uncomfortable with an angioplasty, there are now other alternatives that may be just as effective without the procedure.

Medical researchers, for example, have been evaluating the combined approach using anti-coagulants, thrombolytic therapy (clot-dissolving drugs) and cholesterol-lowering drugs. According to Dr. Eric J. Topol of the Cleveland Clinic, the treatment has been deemed effective in at least a few small studies (1).

Other cardiologists look to intensive-lipid therapy alongside dietary supplements such as fish oil and vitamin D. According to Dr. William Davis, the integrated therapy has been shown to help slow progression of atherosclerosis and even reverse it in asymptomatic adults (2).

Along with treatment, the patient should adopt exercise and special dietary considerations to help provide a complete comprehensive treatment of risk factors including control of hypertension, obesity and type 2 diabetes (3). For this patient, diet should be low in saturated and trans fat, high in fiber, and provide optimal levels of nutrients such as omega-3 fatty acids, and vitamin D for lowering cardiovascular risk (3).

A DASH eating plan can help to meet diet goals. The eating plan, which has been found to lower blood pressure within 15 days, features low-fat dairy products, fish, and lean meats as well as plenty of whole grains, fruits and vegetables. Recently, a study found that a DASH eating plan combined with exercise helped subjects to reduce blood pressure, lose weight, improve mental function, and improve cardiovascular fitness (4).

References

1. Topol EJ. Integration of anticoagulation, thrombolysis and coronary angioplasty for unstable angina pectoris. Am J Cardiol. 1991 Sep 3;68(7):136B-141B.
2. Davis W, Rockway S, Kwasny M. Effect of a combined therapeutic approach of intensive lipid management, omega-3 fatty acid supplementation, and increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic adults. Am J Ther. 2009 Jul-Aug;16(4):326-32. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19092644
3. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.
4. Smith PJ, Blumenthal JA, Babyak MA, Craighead L, Welsh-Bohmer KA, Browndyke JN, Strauman TA, Sherwood A. Effects of the Dietary Approaches to Stop Hypertension Diet, Exercise, and Caloric Restriction on Neurocognition in Overweight Adults With High Blood Pressure. Hypertension. 2010 Mar 19. [Epub ahead of print]

Atherosclerosis

Atherosclerosis refers to accumulation of a thick sludge in patches that merge to form large plaques, called atheromas, in artery walls. The plaque is made up of cholesterol and other fats, macrophages, cell "junk", calcium, and tissues.

LDL cholesterol is associated with atherogenesis because as it becomes oxidized it can induce endothelial cells to attract blood-borne monycytes, transforming them into macrophages and trapping them in endothelial spaces (1).

The macrophages then engorge themselves with cholesterol and fat creating "foam cells. Then, once engorged, they release inflammatory cytokines that only lead to even more macrophages creating more foam cells (1).

Along with damaged smooth muscle cells, the foam cells then form the sludge plaque, or fatty streak, that narrows lumen as it grows larger causing blood flow to to become restricted (1).

Medications

There are various drugs that can help to slow or reverse atherosclerosis, which include cholesterol-lowering drugs such as statins, anti-coagulants such as warfarin to inhibit clotting, antiplatelets like aspirin to keep platelets from forming clots, and medications such as ACE inhibitors or calcium channel blockers to lower blood pressure (2).

If atherosclerosis becomes severe, surgery may be needed. A procedure called an angioplasty can be performed by inserting a catheter with a deflated balloon into an affected artery, then inflated to open the artery. Sometimes a stent, or mesh tube, is left to keep it open.

Other surgeries involve endarterectomy, where fatty deposits are surgically removed from walls, or thrombolytic therapy in which drugs are inserted into arteries to dissolve clots (2).

A bypass surgery (such as a CABG, coronary artery bypass surgery) involves using another part of the body or a tube to allow blood to flow around an affected artery (2).

Lifestyle changes

It is possible to change the course of atherosclerosis -- even possibly reverse it -- by adopting a few lifestyle changes. These include stopping smoking, exercising regularly, eating right and lowering stress.

- Smoking in itself oxidizes LDL cholesterol and hastens the damage of arteries.
- Exercise improves blood flow and can induce the development of new blood vessels to lower the pressure on affected arteries.
- Eating right should include adopting strategies such as managing portions for weight management, a DASH-style diet for lowering blood pressure, limiting saturated and trans fatty acids and adopting polyunsaturated fats to lower triglycerides, and eating a high-fiber diet to lower cholesterol levels (1).
- Limiting stress in life through relaxation and sleeping well helps to avoid rises in blood pressure.

Overall, it's very likely that almost half of us will die from atherosclerosis or complications relating to it. Almost all of us have fatty streaks and plaques already developing. These are disheartening figures for those of us who wish to do all we can to fight back.

Luckily, our nutrition and medical knowledge continues to improve and new technologies are also forming.

One program of interest is the one promoted by cardiologist Dr. William Davis in his book Track Your Plaque, who promotes actively "tracking" the progression of plaque development (3).

In addition, Dr. Davis and fellow scientists have studied the effects of combined therapies involving niacin or statins, fish oil, vitamin D and other means to slow or reverse "hardening of the arteries" (4).

Reference List


1. Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. Belmont, CA: Thomson Wadsworth, 2009.
2. http://www.mayoclinic.com/health/arteriosclerosis-atherosclerosis/DS00525/DSECTION=treatments%2Dand%2Ddrugs
3. http://www.trackyourplaque.com
4. Davis W, Rockway S, Kwasny M. Effect of a combined therapeutic approach of intensive lipid management, omega-3 fatty acid supplementation, and increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic adults. Am J Ther. 2009 Jul-Aug;16(4):326-32. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19092644

Sodium: How much is right for you?

Sodium’s association with high blood pressure is well known. However, sodium also plays a large role in keeping you healthy. It’s important to know how to strike the right balance.

Along with potassium, sodium is essential for fluid balance, facilitating the flow of water in and out of cells to bring nutrients in and take wastes away. Sodium also has a role in the regulation of blood pressure and helping muscles and the heart relax. Each sodium ion contains an electrical charge, acting as an electrolyte, which allows transmission of nerve impulses to the brain and throughout the body.

Sodium levels in the body are controlled by the kidneys. If the body doesn’t receive enough sodium daily—a chronic problem for our early ancestors—then the kidneys retain sodium. When the body has a high enough amount, then the excess sodium is excreted in the urine.

At times, sodium levels may fluctuate. If a person has a dysfunctional kidney, then the body may retain too much sodium, which can result in edema, or swelling in the legs and feet because sodium attracts water. In contrast, diarrhea or vomiting may result decreased sodium levels, a condition known as hyponatremia.

How sodium regulates blood pressure is not entirely understood, but there is an established link between high sodium intake and high blood pressure. As expected, there is also a link between sodium reduction and lower blood pressure.

The sodium-hypertension relationship may also have to do with how sodium interplays with other minerals such as potassium and calcium. Potassium, for example, appears to assist the kidneys in shedding excess sodium. Lowering sodium intake also helps to conserve calcium, which may affect blood pressure.

Recommendations for Sodium

The Institute of Medicine is recommending an Adequate Intake of sodium at 1,500 mg per day for adults and children 9-13 as well as 1,000 mg and 1,200 mg per day for children ages 1-3 and 4-8, respectively. These levels are considered appropriate for replacing daily losses via sweat and urine. The need for sodium may be slightly greater if exercise produces excessive sweating or if a person has symptoms of vomiting or diarrhea.

On average, however, most adults in the U.S. consume about 3,200 milligrams or more a day. With these figures, it is easy to understand why high blood pressure affects nearly 75 million Americans. The average intake is well above the Institute of Medicine’s Tolerable Upper Intake Level of 2,300 milligrams per day for adults and 1,500mg, 1,900mg and 2,200 mg for children ages 1-3, 4-8 and 9-13, respectively.

Cutting sodium intake daily tor recommended levels is important and it doesn’t have to be difficult with these three simple strategies:

Sodium Strategy #1: Limit processed or prepared foods high in sodium. Most sodium in the diet doesn’t come from the salt shaker, but from processed and prepared foods. Thus, the best way to lower sodium is to reduce intake of processed foods or replace them with low-sodium alternatives. This includes ready-to-eat packaged foods such as potato chips, fast-food meals such as burritos, and highly salted meals prepared at restaurants.

Sodium Strategy #2: Learn to enjoy food without salt. Taste food before salting it; the food may already be salty enough or it may be enjoyed without salt. In fact, salty is an acquired taste. The body and taste buds can easily adjust to less salt. Studies have shown that as people reduce salt intake and stick to a relatively lower intake of sodium, they will naturally begin to prefer foods with less salt. When eating at home, try not having the salt shaker on the table and, if eating out, simply move salt shakers to another table. When preparing food, try using less salt and seasoning food with spices or salt-substitutes instead. Keep an eye on store-bought spice blends, though, as many may contain high amounts of salt.

Sodium Strategy #3: Balance sodium with potassium-rich fruits and vegetables. A clear association exists between higher potassium intake from fruits and vegetables and lower blood pressure regardless of sodium intake. Potassium helps the kidneys in promoting sodium excretion, reduces urinary calcium and magnesium (which influence blood pressure), supports smooth vascular muscle health, and helps with regulation of blood pressure.

Less Sodium in a DASH

Most people who are interested in maintaining healthy blood pressure levels would do best to follow a DASH (Dietary Approaches to Stop Hypertension)eating plan. In the well-known DASH-sodium study, which was conducted by the National Heart, Lung and Blood Institute, people following the diet lowered blood pressure in just 14 days even without reducing salt intake.

The DASH eating plan includes consuming a diet rich in low-fat, low-sodium dairy products, fish, chicken and lean meats as well as large amount of whole grains, fruits and vegetables.

When a person is concerned about blood pressure, the best advice nutritionists can give is to begin following a DASH eating plan combined with regular exercise and weight management. In fact, according to a recent study in Hypertension, this plan helped people reduce blood pressure, lose weight, improve mental function, and improve cardiovascular health.

Taking the Pressure Off of Sodium

It’s extremely easy to place all of the blame for society’s high blood pressure woes and medical costs on sodium, but the mineral’s role in the body should not be ignored. Sodium is essential for good health and too little could lead to other health issues, including deficiencies in iodine, which is mainly provided in the North American diet from iodized salt.

While lowering sodium consumption can lead to a natural preference for foods with less salt, it’s important not to cut salt out completely. Because the body requires some sodium to function properly, avoiding salt entirely might backfire, and cause cravings for high-sodium foods. As with almost all vitamins and minerals, the key to healthy sodium intake is always balance with other nutrients. A DASH eating plan and strategies for maintaining a healthy intake (such as those given above) can help you achieve this balance of nutrients for healthy blood pressure levels and optimal health.

Reference

Dyuff RL, American Dietitic Association. American Dietetic Association Complete Food and Nutrition Guide, 3rd edition. 2006. Wiley.

More reason to love olive oil

I use one particular olive oil for cooking and another extra-virgin olive oil to mix with some balsamic vinegar for my salads. Olive oil, as the staple source of fatty acids in the Mediterranean diet, has also been heavily researched for its health benefits especially in comparison to other sources of fat such as butter, corn or soy oil.

On April 20, a study in BMC Genomics was published that found that olive oil eaten at breakfast modified gene expression in patients with metabolic syndrome (1). The breakfast caused the changes in mononuclear cells after intake of the olive oil and repressed pro-inflammatory genes (1).

The study was performed on 20 patients in a double-blind randomized trial (1). The researchers noted that many of the genes were also implicated in type 2 diabetes, dyslipidemia and obesity (1).

The study adds to evidence that olive oil helps reduce inflammation unlike other oils such as butter (2) and, thereby, adds to the reasons why the Mediterranean diet is associated with lower risk of cardiovascular disease (3).

References

1. Camargo A, Ruano J, Fernandez JM, Parnell LD, Jimenez A, Santos-Gonzalez M, Marin C, Perez-Martinez P, Uceda M, Lopez-Miranda J, Perez-Jimenez F. Gene expression changes in mononuclear cells from patients with metabolic syndrome after acute intake of phenol-rich virgin olive oil. BMC Genomics. 2010 Apr 20;11(1):253. [Epub ahead of print]

2. Bellido C, López-Miranda J, Blanco-Colio LM, Pérez-Martínez P, Muriana FJ, Martín-Ventura JL, Marín C, Gómez P, Fuentes F, Egido J, Pérez-Jiménez F. Butter and walnuts, but not olive oil, elicit postprandial activation of nuclear transcription factor kappaB in peripheral blood mononuclear cells from healthy men.Am J Clin Nutr. 2004 Dec;80(6):1487-91.

3. Bellido C. Perez-Jimenez F, Alvarez de Cienfuegos G, Badimon L, Barja G, Battino M, Blanco A, Bonanome A, Colomer R, Corella-Piquer D, Covas I, Chamorro-Quiros J, Escrich E, Gaforio JJ, Garcia Luna PP, Hidalgo L, Kafatos A, Kris-Etherton PM, Lairon D, Lamuela-Raventos R, Lopez-Miranda J, Lopez-Segura F, Martinez-Gonzalez MA, Mata P, Mataix J, Ordovas J, Osada J, Pacheco-Reyes R, Perucho M, Pineda-Priego M, Quiles JL, Ramirez-Tortosa MC, Ruiz-Gutierrez V, Sanchez-Rovira P, Solfrizzi V, Soriguer-Escofet F, de la Torre-Fornell R, Trichopoulos A, Villalba-Montoro JM, Villar-Ortiz JR, Visioli F. International conference on the healthy effect of virgin olive oil. Eur J Clin Invest. 2005 Jul;35(7):421-4.


David

Fibromyalgia

Fibromyalgia, or chronic fatigue syndrome, has increased by 200 to 400 percent in the last decade and now affects approximately 6-12 million Americans. It's a syndrome with symptoms of hormonal, sleep and autonomic control dysfunctions.

Those with fibromyalgia often suffer from widespread pain in muscles, poor sleep, and low energy levels. Co-existing conditions are food reactivities and irritable bowel syndrome, migraine headaches, chronic sinusitis, restless leg syndrome and sleep apnea.

Medical treatment may include analgesics for pain relief such as with acetaminophen or NSAIDS. Most will require treatment for hypothyroidism with Armour Thyroid. A Cortef prescription or supplementation with adrenal glandulars or licorice is also helpful for adrenal support. Lastly, sex hormone therapy may be needed.

Nutritional support may include supplements of iron to guard against iron-deficiency anemia,which may contribute to lacking energy, as well as coQ10, which is fat-soluble antioxidant needed in the mitochondria for production of energy. In addition, acetyl-l-carnitine may be helpful for supporting mitochondrial energy and d-ribose may help increase energy and reduce pain.
Reference
1. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.

Losing weight easy on the Zone Diet

The power behind Dr. Barry Sears's Zone diet is that it offers people simple techniques to be used as part of their eating plan, which makes lower-calorie eating on a high-protein, moderate-carb plan simply easier to follow. 

I've made a list below of a few of the techniques that I've used successfully  to help "stay in the zone," as Dr. Sears calls it, and keeping to a 40-30-30 ratio of carbs, proteins and fats: 

Protein - Decide on the amount of protein you should have by comparing size (e.g. of a chicken breast) with the thickness of your palm.  

Carbs - If it's a "good" (high-fiber; low-glycemic) source of carbs, then the portion should equal the size of  two fists, but if it's a "bad" source (low in fiber; high-glycemic) the portions should equal the size of one fist

Fats - If the protein has fat, don't add any. If it doesn't, then choose nuts or olive oil.  

Simple, right? Then, just eat frequently throughout the day by never letting five hours pass without a snack or meal. And you can generally apply it to a DASH-style, Mediterranean-style or Paleo-style diet.

The Zone diet ratio of protein/carbs/fats is all about keeping your body working efficiently while keeping blood sugar and calories in check. It's not about being complicated or restrictive -- which ultimately the greatest cause for diet failure because it leads to bingeing.

Cordain vs Campbell

I recently read what is entitled the "Protein Debate" between Loren Cordain, a paleo diet proponent, and Colin Campbell, a plant-based diet proponent. Given that I'm simply a graduate student without any specific adherence to either diet philosophy, i found the debate to be fascinating. Both had strong points to defend their positioning. In short, this is how it goes:

• Loren Cordain argues that because nutritional science is a young, evolving science with little agreement as to what is correct in eating for the general population, they should have a "guiding paradigm" based on the diet of our hunter-gatherer ancestors. The paleolithic diet would be one that include high amounts of protein from lean meats and minimally processed foods of paleolithic resemblance.

• Colin Campbell argues that nutritional science is not young (it's older than many other sciences) and, that, although knowledge of ancestral diets may be helpful, "biological complexity" throws out its use as a reference standard (after all, high calorie intake from meat may have increased likelihood of reproduction, but not guarded against disease). The priority should be given to searching for dietary factors that cause "collective disease and health outcomes" to guide nutritional recommendations.

You decide. They could, in fact, both be right and wrong on different levels. David

Thoughts on High Fructose Corn Syrup

There are some really wacked people on the Internet who try to blame the whole obesity epidemic on HFCS, fructose or agave and are misguiding everyone. I liken it to the same misguidance that occurred in 1980s when everyone was scared of fat.

You shouldn't just cut out HCFS and replace it regular sugar or another caloric sweetener. It's really overeating, the overabundance of calories much of it from sugar, that in general contributes to this obesity problem.

What our real problem is is that our brains are wired for fats, carbs and salt that has led us into this obesity crisis now. As a whole, our species needed this wiring to seek out nutritious foods that helped us survive.

But in this modern world of aplenty, the answer to our obesity problem is to control our brains (or trick them with artificial stuff) and use simple discipline, portion control and balanced, nutritious meals.

Sucralose (Splenda)

Sucralose has been on the market for about two decades now and has been touted as a quite the wonderful artificial sweetener. The safety profile of sucralose has been excellent in adults and it has already helped many with type 2 diabetes to manage blood sugar without having to give up on many of their favorite foods and beverages.

Because of increased use of Sucralose over the years, however, high concentrations of it has been popping up in the environment and there have been worries about how the artificial sweetener may influence infants, children and even animals. One big worry has been potential affects on brain growth.

Two Swedish researchers, Dr Viberg and Dr Fredriksson set out to study the possible neurotoxicity of sucralose in mice. They gave just mice an oral dose of 5-125 mg of sucralose per kilogram bodyweight per day on days 8 through 12 immediately after their birth.

Then, the researchers killed the mice and analyzed their brains. They checked for key proteins and found no alterations that would indicate a disturbance to neuronal development.

Thus, they concluded, sucralose "seems to be a safe alternative for people", and possibly even during pregnancy, as it does not affect growth and development of the brain.

Reference

Viberg H, Fredriksson A. Neonatal exposure to sucralose does not alter biochemical markers of neuronal development or adult behavior. Nutrition. 2010 Jan 27. [Epub ahead of print]

High cola intake may cut sperm count, reports Danish study

Men who drink a few too many Diet Coke or some other cola-like beverages daily may have fewer sperm, according to a new study.

The study, published in the April 15, 2010 issue of American Journal of Epidemiology (1), had examined the semen quality of more than 2,500 young Danish men who had been recruited upon was evaluated for fitness and military service.

They found that those subjects who reported on a questionnaire that they consumed high amounts of caffeine (more than 800 mg per day) or high intakes of cola (more than 14 half-liter bottles per week) had reduced sperm concentration and total sperm count. On the other hand, the consumption of only moderate amounts of caffeine (less than 800 mg per day) or low amounts of cola (less than 14 half-liter bottles per week) were not associated with any similar effect on sperm concentration or count.

There was no association established between caffeine from tea or coffee and influence on sperm count.

The Copenhagen researchers of University of Denmark of Growth and Reproduction concluded that they "cannot exclude the possibility of a threshold above which cola, and possibly caffeine, negatively affects semen quality" (1).

They added, "Alternatively, the less healthy lifestyle of these men may explain these findings" (1).

Still, if you're interested in maintaining your vitality (who isn't?), it may be better to avoid the cola!

Caffeine and Semen Quality

There have been several studies that have investigated caffeine and a possible association with semen quality, which have led to conflicting results.

Previous to this study on high intakes of cola, there had been a pregnancy cohort in 2008 on more than 5,000 males that evaluated semen quality in association with prenatal coffee and caffeine exposure (2).

The study, also from Denmark, found that although high caffeine intake didn't have any significant effect on semen quality, it did lead to increased testosterone concentrations (approximately 14 percent) in the men (2).

So, until more research is conducted, there's still no need to give up on the coffee.

References

1. Jensen TK, Swan SH, Skakkebaek NE, Rasmussen S, Jørgensen N. Caffeine intake and semen quality in a population of 2,554 young Danish men. Am J Epidemiol. 2010 Apr 15;171(8):883-91. Epub 2010 Mar 25.

2. Ramlau-Hansen CH, Thulstrup AM, Bonde JP, Olsen J, Bech BH. Semen quality according to prenatal coffee and present caffeine exposure: two decades of follow-up of a pregnancy cohort. Hum Reprod. 2008 Dec;23(12):2799-805. Epub 2008 Aug 28.

Luo han guo - a source of xylitol

Louo han guo is a fruit that has been recently hyped up and marketed as a natural sweetener. What is it really? It's really just a source of xylitol. Xylitol is a natural sugar alcohol, which is not digested as easily by the body lending fewer calories per gram than regular sugar. The polyol also has a slight cooling effect, which you would recognize while eating sugarless gum like Trident.

Xylitol was first discovered and isolated in Sweden from birch bark. It is also now widely used in Sweden (where it was first isolated) and used in all sorts of candies there.

Regular use of xylitol is associated with significant reduction of cavities and tooth remineralization (1). Why? Because research shows that xylitol doesn't contribute to tooth decay and, unlike other sugar alcohols like erythritol, it may even help fight cavities by a mechanism of confusing cavity-causing bacteria to eat it and basically die.

Reference

1. Mäkinen KK. Sugar alcohols, caries incidence, and remineralization of caries lesions: a literature review. Int J Dent. 2010;2010:981072. Epub 2010 Jan 5.