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Jan4

How Losing Weight Helps Your Heart. Are You Actually Overweight?

Posted in: High Cholesterol, Hypertension, Obesity and Weight Loss, Wellness and Health

The first big JAMA study of the new year (Happy New Year!) implied that you can be overweight or barely obese, and not die early because of it.

In between the lines: yes….in that population. Why?

Because they get medical care right away!. Because they get sicker sooner! Because their pre-diabetes, hypertension and high cholesterol gets screened for and picked up and treated! And because being sick–like with cancer, immune disease, and heart disease–can make you less fat, because you feel sick!

Plus, looked at internationally (as this study did), people of lower weight were often malnourished and sickly, and in some cases, starving.

So much for “spinning the data.”

Here is what you need to know about who is actually overweight, and why weight loss treats heart disease.

74% of men and 68% of women in the U.S are overweight or obese, and the rest of the world is rapidly catching up. Most men and women don’t know where they fall. You can measure your body mass index (BMI), measure your kid’s BMI, or just look below: for both men and women:

If you’re 5-foot-10-inches, normal is 132 -167 pounds; an overweight is 172- 202 pounds, obese is 209- 236 pounds; severely obese starts at 243; morbidly obese starts at 278.

If you’re 5-foot-5-inches, normal 114-144; overweight 150-174; obese is 180-204; severely obese starts at 210; morbidly obese starts at 240.

Weight loss helps your heart because it lowers your blood pressure and your blood lipids including triglycerides and LDL cholesterol; it helps you metabolize sugar more efficiently; it improves insulin sensitivity; and it reduces inflammation. And inflammation probably causes heart disease.

Not to mention makes it easier for the heart to pump blood where it needs to go!

No one said it was easy to lose weight and keep it off: crappy, cheap, alluring high-calorie low-nutrient foods are everywhere. Produce is not as cheap or accessible as highly processed food. People often don’t have sit down meals, and motivation is a very weak leg on which to stand. What you need is a plan, accountability, self-monitoring and the right foods for you.
Nov8

Research on Men: Why They Don’t Go to Doctors (and what might help)

Posted in: Aging and Costs of Aging, Common Conditions, Obesity and Weight Loss, Wellness and Health

At KevinMD, Dr. Joel Sherman writes smartly about why men avoid going to the doctor. One reason: it reminds them of mortality. A second reason: a potential prostate exam. A third: they have to wait, a lot. Plus, telling a female receptionist about a male-related problem is not great.

Note to middle aged men: erectile dysfunction is an early warning sign for heart disease, until proven otherwise.

Men get more heart disease and die younger than women. Going to the doctor is usually an event (a screening exam, unable to move because of back spasm or broken limb) rather than a process (cancer prevention, for example). Research on men backs this up.

In my office, men often come in for lifestyle advice, weight loss help or nutrition consultation if they have a close friend or relative who recently became ill. Say, someone who had a high calcium score (over 400) or had a heart attack or prostate disease diagnosis.

That’s especially true in men under 60; men over 60 know they need to protect their health. And they know that seeking help is an acceptable behavior, as is staying healthy.

Sometimes another doctor requires them to come in, or a wife/girlfriend/mother/daughter/lover makes them. It takes courage to come in.

45% of men don’t have a primary care physician, and 10% can’t remember when they last saw a doctor. 9% would avoid doctors even if they had blood in urine or semen.

On KevinMD, above, a nurse writes about her husband: “He’s a little overweight (20lbs). He says, “I’ll go when I lose weight”.

It’s understandable that men feel that way. But not necessary. What if it was a game, or competitive, or there were rewards involved, or it was actually fun?
Aug23

It’s Time for Some Q and As

Posted in: Diabetes, Food FAQ's, High Cholesterol, Vitamins and Supplements, Wine and Tea

I am taking a short break from farming activities (avocados, anyone?) and newsletter writing to answer some reader questions. You can also post these on Facebook or Google Plus and I will try to answer there.

Q. I am wondering if you think it is a good idea to minimize the cheese, chicken and fish animal proteins? The research I have read suggests that the positive qualities of those products can be found in plant based foods, and without the saturated fat, cholesterol or mercury. My understanding is that type 1 diabetes has been linked to the casein in cows milk when given to infants, and that animal protein may be related to auto-immune diseases.

A: In general, yes, about animal proteins–moderate more than minimize.

I think most of the problem is in overprocessing and some of the hormones and toxins with which they are raised/to which they are subjected, instead of the saturated fat and cholesterol.

Cholesterol in food (unless you eat 2# of shrimp or 3 egg yolks daily) doesn’t raise cholesterol in the blood.

Most saturated fat probably raises the risk of heart disease but food is a mix of nutrients, and I think its source is the main thing.

The other question is harder: type I diabetes has been linked to casein, but so has latitude, and the confounding factor may be vitamin D levels: http://www.ncbi.nlm.nih.gov/pubmed/19100644.

Infants exposed to casein early in life may be at increased risk for diabetes, but the data are not conclusive.

So I would not avoid milk because of diabetes risk, but I would want to know where the milk came from, whether the cow received rBGH, growth promoters and so on.

Of concern, Japanese cattle recently ate radioactive rice straw; whether it harms people to eat radioactive milk is unknown, except in high doses…but the yuck factor is pretty high.

Q. Hi, I saw you for the first time on PBS yesterday and was intrigued. I recently lost my job and health insurance and figured since I eat everyday, I might as well eat better. It has to be cheaper than healthcare insurance. I’m Mormon and don’t drink alcohol. Is there a non-alcoholic drink that has the benefits of wine?

A. Red grape juice, pomegranate juice and other dark fruit juices do provide many of the benefits of wine.

However, alcohol raises HDL, which juices do not, but they do provide tannins, flavonoids and anti-inflammatory chemicals which are helpful with inflammation.

Q: You seem to be looking at and using a variety of ways to share your information to as many people as will listen. Which I think is fantastic. Have you considered a weekly or monthly conference call for people using a service, like go-to-meeting.com, where you can have interactive discussions or presentations? I have no clue what is required on the presenter’s part, however.

A: I have thought about it and like the idea. I’ll send out a poll to newsletter subscribers and ask if they would like that, and how much it should cost.

I think I would likely use Skype (Kris Carr uses it for her coaching, apparently) and I think it would be fun. Let’s see!
Aug9

Do Statins Raise Diabetes Risk?

Posted in: Aging and Costs of Aging, Diabetes, High Cholesterol, Vitamins and Supplements, Wellness and Health
Probably, in higher doses.

A study of 18000 people without heart disease, called JUPITER, shows that Crestor (rosuvastatin) 20 mg showed that for every 1000 patients on high dose (40mg and up) statins, there are 6 more cases of new diabetes over 2 years.

Crestor also prevented 11 cases of heart attack, stroke, arterial revascularization, hospitalization or death from heart disease, in that 1000 patients.

The newest study includes 32,752 patients without heart disease. Again, 2 cases of diabetes, versus 6 or more cardiac events prevented in a 1000 people over 5 years.

If you actually have heart disease or angina, then the numbers for taking a statin are different.
- 1 in 83 life saved
- 1 in 39 prevented a non-fatal heart attack
- 1 in 125 prevented stroke
- 1 in 167 developed diabetes
Is that worth the trade-off?

I try to find ways for my own patients to get off high doses of statins, especially 80mg doses, because of myopathy and pain.

A cholesterol registry can chronicle how people control cholesterol naturally.

I suggest that any patient 40 and over get screened every 3 years, and make sure they don’t suffer from abnormal lab test syndrome. And I help them make lifestyle changes that help them reduce their need for cholesterol medication.

Statins can be important medications, and their benefits can be greater in diabetics than nondiabetics.

But there’s no sense in tempting fate. Let’s enjoy life, and avoid getting diabetes in the first place. Lower your cholesterol with what you eat.
Apr18

Is Sugar Toxic? Gary Taubes’ Lab Reports

Posted in: High Cholesterol, Obesity and Weight Loss, Wellness and Health

Gary Taubes blew the top off the New York Times readership with his carefully researched “What if it’s all been a big fat lie?” about fat and heart disease in 2002 (translation: it’s the type of fat that matters, not total fat).

He’s doing it again with “Is Sugar Toxic? (translation: yes, it’s poisoning you now).

Now he posts his state-of-the-art lipid lab results (which I also order for patients) to prove his minimal heart disease risk. He eats primarily meat and eggs.

Any of my patients would be proud: (except one thing: the CO2 of 19, which is probably because he’s often ketotic, and has to blow off CO2 to normalize his blood pH).

Three questions:

a. What is the effect of sustained ketosis on heart disease risk?.

Ketosis mimics starvation, pushing the body to burn fats rather than carbs (because there are no carbs!) for fuel. Fatty acids and ketones result.

Ketogenic diets work in about 50% of kids with specific seizure conditions. They reduce appetite but are difficult to sustain (Atkins is a modified ketogenic diet). In a small study in kids, there were worrisome cardiac changes: I don’t know of adult cardiac data.

b. What are the other heart disease risk factors? Smoking, high blood pressure, diabetes and pre-diabetes, sedentariness, family history of early heart disease, high waist-to-hip ratio.

Let’s assume these are not a problem for Mr. Taubes. But not so for everyone else. Some of these have to do with food, and some not. Even if sugar is the problem. And it might be.

c. Is it practical?

To eat without most carbs and sugar, especially fructose, is virtually impossible in the U.S. and even more so abroad.

But Taubes’ idea that “we all respond to the carbohydrate/insulin effect differently”, and for weight loss “getting rid of all the grains and much or most of the fruit, and then eating more of whatever foods they happen to eat or like that provide protein and fat” deserve exploration.

People with celiac disease learn to cook, to read labels, to avoid gluten, because it’s toxic to them. Will we see the same for obesity, heart disease and sugar? Let’s hope so.