That's Just Great: ANOTHER Epidemic to Worry About!

Metabolic Syndrome affects nearly four of every 10 adults in the U.S., yet most people aren't familiar with it.  The syndrome itself is without symptoms.  The problem is that Metabolic Syndrome increases your risk of type 2 diabetes by five-fold, and doubles your risk of developing cardiovascular disease - heart attacks, strokes, poor circulation - over the next five to 10 years.

"How would I know if I have Metabolic Syndrome?" 

Your doctor might tell you, or you can determine it yourself if you know some of your lab values and blood pressure.  The syndrome is defined simply by the presence of at least three of the following five criteria:

1. Waist circumference over 102 cm (40 inches) in men, or over 88 cm (35 inches) in women
2. Serum triglycerides over 150 mg/dl (or already on drug therapy for high triglycerides)
3. HDL cholesterol under 40 mg/dl (men) or under 50 mg/dl (women) (or on already on drug therapy for low HDL)
4. Systolic blood pressure over 130 mmHg and/or diastolic over 85 (systolic is the first or top number) (or already on drug therapy for high blood pressure)
5. Fasting blood glucose level over 100 mg/dl (or already on drug therapy for elevated glucose)

Some physicians argue that there's no reason to label someone as "Metabolic Syndrome."  Others feel that the moniker has helpful therapeutic impact.  The can say, "Look, Mr. Johnson, I care about you and your future health.  Since you have Metabolic Syndrome, over the next decade you have a five-fold increased risk of diabetes and double the risk of heart disease.  Let's talk about how we might reduce that risk before it's too late."

"How can I prevent or even treat Metabolic Syndrome?"

Work with your personal physician, of course.  And consider the following information available at NutritionData:

• Lose excess fat weight
• Start exercising regularly
• Low-glycemic-index eating increases HDL cholesterol, lowers triglycerides and blood sugar, and reduces risk of type 2 diabetes
• The DASH diet lowers blood pressure

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

Salt Restriction: Good In Theory, But Impossible to Implement?

Reducing salt intake might be a good idea, but it may not matter since our bodies have irresistible physiologic mechanisms to defend a higher level of salt intake, according to a new report in the Clinical Journal of the American Society of Nephrology.

Another push to lower salt (actually, sodium) intake in the American public started a few years ago.  The idea is that sodium restriction will lower blood pressures, leading to fewer heart attacks and strokes.  That proposition itself is debatable.  The medical/nutrition community hotly debated it 20 years ago.  There are reasonable arguments on both sides.

The authors of the study at hand don't address whether sodium restriction would be healthful.  They question whether any measures at the public health level can even work.  Their answer: probably not.

The Institute of Medicine in 2003 recommended 2,300 mg/day as the upper limit of dietary sodium.  The USDA's 2005 Dietary Guidelines recommend 1,500 mg/day for people at risk of hypertension.

The authors conclude that the average person has powerful physiologic mechanisms working to keep sodium intake around 3,000 mg/day, at least. 

They studied the salt consumption of widespread, diverse populations, including those who were carefully instructed and motivated to reduce salt intake.  In this case, it seems you just can't fight Mother Nature.

I think perhaps two of every 10 people may have blood pressures sensitive to salt intake.  Let's try to identify and target them for intervention rather than attempting sweeping societal changes that affect us all.

If I had elevated blood pressures, I'd make an attempt to reduce my sodium intake over a two or three month trial and note the effect.  You can calculate and monitor your sodium intake with NutritionData's "My ND/My Tracking" feature.  I'd also start exercising regularly and lose my excess body fat.

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

References:  McCarron, David, et al.  Can dietary sodium intake be modified by public policy?  Clinical Journal of the American Society of Nephrology.  4 (2009): 1,878-1,882.

Does Sex Cause Heart Attacks?

I have good news and bad news.  Which do you want first?  OK.  Yes, sexual activity does cause heart attacks, but not many.  And you can take steps to reduce sex-induced heart attacks.

If you watch TV, you can't miss all those adds for Viagra, Cialis, and Levitra.  One of them cautions, "Be sure to check with your doctor to see if you're healthy enough for sexual activity."  In over two decades of medical practice, I've had only two people ask me; they had previous heart attacks.

I'll assume you have a good idea what I mean by sexual activity.  Two consenting adults, more than just a peck on the cheek . . . Intercourse, in other words.

Early studies of volunteers in labs showed dramatic changes in vital signs during sexual activity: heart rates up to 140-180 beats per minute, blood pressures increased by 80 points, respiratory rates comparable to moderately severe physical exertion.  That could put a major strain on the heart and cause a heart attack in someone with risk factors.

Later studies of married couples in real-life settings found heart rates averaged 117 (lower than rates during normal daily activities), and blood pressures around 160/90 mmHg.  The work load of average sexual acitivity is equivalent to walking at 2-4 miles per hour on a level surface.  Your mileage may vary.

Surveys of heart attack patients reveal that the relative risk of a heart attack within two hours after sex is 2.5.  Huh?  If your risk of a heart attack at a given time is 1 in 5000, your risk of a heart attack within two hours of sex is 2.5 in 5000.  [I pulled 1 in 5000 out of thin air for illustrative purposes.]  Risk is less in people who exercise regularly. 

Put in other terms, sexual activity contributes to onset of heart attack in only 1% of patients.

Several conditions increase the risk for a sex-induced heart attack: prior heart attack, other known heart diseases (e.g., angina, heart failure, heart valve problems, rhythm disturbances), previous heart bypass or angioplasty,  and uncontrolled high blood pressure.  Work with your doctor to manage these.  A treadmill stress test can be very reassuring.

Also, increase your fitness level through regular exercise.  NutritionData's Four Weeks to a Fitter You will help you get started.

-Steve Parker, M.D. 

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

Fish: Still Good for Your Heart, But Doesn't Prevent Heart Failure

Dutch researchers recently reported that consumption of fish doesn't seem to protect against onset of heart failure, while noting good evidence that it prevents heart attacks, sudden cardiac death, and strokes.  Details are available at HealthDay. 

Scientists studied 5,299 men and women over the course of 12 years in the Rotterdam Study.  Heart failure developed in 669 of them.  Diets were analyzed, with attention to fish rich in omega-3 fatty acids.  The full report is in the October issue of European Journal of Heart Failure.

Omega-3s are linked to lower heart rate, reduced blood pressure, lower triglyceride levels, and suppression of abnormal heart rhythms.   

Whether results of this study apply to different ethnic groups or nationalities is debatable.  A prior study of older adults in the U.S. had found an association between higher fish consumption and less heart failure. 

Fish with the highest omega-3 content include trout, salmon, sardines, mackerel, sea bass, swordfish, herring, halilbut, and tuna (white or albacore).

Here are other Steps to Prevent Heart Failure, since fish let us down.

Not familiar with preparing and eating fish?  Check out NutrtionData's sister site, Epicurious.com.  Their page entitled "Our Favorite Seafood Recipes" has links to:

• sustainable seafood information
• seafood preparation technique videos
• recipe: Sea Bass with Citrus and Soy
• recipe: Halibut with Roasted Beets, Beet Greens, and Dill-Orange Gremolata

-Steve Parker, M.D.

Reference: HealthDay. Study finds fish won't benefit heart failure.  September, 30, 2009.  [Link will expire December 29, 2009.]

Flu Vaccine Protects Against Heart Attack? What the . . . !

Unless you've been living under a rock recently, you may have noticed a slight push to get vaccinated against the flu.  This will intensify since the Swine flu H1N1 vaccine will be available in next month.  That's why my ears perked up when I read that flu vaccine may protect against heart attacks.  

According to the article in HeartWire from TheHeart.Org from WebMD, a meta-analysis from the UK found two randomized studies examining the protective effect of flu vaccination against death from heart disease, in people with preexisting heart disease.  One study showed a benefit from vaccination, the other was inconclusive. 

That's pretty weak linkage between heart attacks and flu vaccination.

To the extent that heart disease can be aggravated by stress - psychological or physical stress - it makes sense that adding the flu on top of heart disease could be a bad combination.  That's enough reason for heart patients to seriously consider flu vaccination.

As for the Swine flu H1N1 vaccination, you'll have to decide for yourself whether to believe the public health officials' exhortations that the vaccine is reasonably safe.  It will be 3-5 months before we know if dire predictions of a serious Swine flu H1N1 pandemic come true or not.  By then, there may be no more vaccine, or it may be too late to take effect.

Would you like a sure-fire, magic-bullet nutritional approach that prevents all cases of the flu?  Sorry...I don't have one.  I generally follow the kind of food advice Monica Reinagel dispenses in her NutritionData Blog. 

That, and good handwashing technique.  And avoid secretions from sick people when able.

Do you plan on taking the Swine flu H1N1 vaccine?  

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

References:

Wood, Shelley.  Flu vaccine may protect against MI.  TheHeart.Org, September 21, 2009.

Warren-Gash, C, et al.  Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: A systemantic review.  Lancet: Infectious Disease, 9 (2009): 601-610.

How To Stay Off the Heart Transplant Waiting List

Hearts for transplantation are in short suppy, so it's best if you never need one.  Read on to find out how to keep your heart healthy. 

Worldwide, there are 5000 heart transplants annually.  The typical recipient is 50-60 years old and has end-stage heart failure causing major symtoms unresponsive to maximal medical therapy.  Symptoms include shortness of breath (especially with exertion, but even at rest), extreme fatigue and low energy, and swollen legs.

Four or five of every 10 transplant recipients has an underlying non-ishemic cardiomyopathy, which means a weak heart muscle that is not caused by blocked arteries to the heart.  Many of these cases are of unknown cause, but others are related to virus infections, heredity, or drugs (alcohol, cocaine).  The list of potential causes is long. 

Three or four of every 10 heart transplants are related to coronary heart disease: atherosclerosis blocking arteries that supply oxygen and nutrients to the heart muscle.  Those blockages can cause death of heart tissue (heart attacks), or just inadequate blood flow in numerous arteries that cannot be improved with a bypass operation or angioplasty. 

Coronary heart disease is the area in which you have at least some influence on whether you'll ever need a heart transplant.  Reduce your odds of being on the heart transplant list by:

• not smoking
• exercise regularly
• eat a heart-healthy diet
• achieve and maintain a healthy weight
• keep your blood pressure under 140/90

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

The Brain-Heart Connection: What Do Strokes and Heart Attacks Have In Common?

If you've been working hard to reduce your risk of heart disease, you'll be happy to learn that what's good for your heart is just as good for your brain.  Risk factors for heart disease have a large degree of overlap with risk factors for strokes, the third leading cause of death in Western societies.

The connection between brain and heart health is the arterial circulation that supplies life-giving blood to both organs.  Nearly all heart attacks are caused by atherosclerosis, aka hardening of the arteries.  A large number of strokes, by the same token, are caused by atherosclerosis. 

Eighty percent of all strokes are caused by poor or nonexistent blood flow to part of the brain, causing brain damage.  The poor blood flow, in turn, is often caused by clogged arteries or a blood clot that forms in a diseased, atherosclerotic artery.  The other twenty percent of strokes is caused by bleeding within the brain. 

So help your brain and your heart by working on risk factor modification:

• keep your blood pressure under 140/90
• keep your weight under control
• don't smoke
• keep your cholesterol levels reasonable
• exercise regularly

Am I starting to sound like a broken record?  [These days, do people even know what a record is?]

-Steve Parker, M.D.

Prevent Cardiac Deaths With Chocolate? Sounds Too Good To Be True!

For people who have had a first heart attack, chocolate consumption dramatically reduces the odds of dying from a future heart attack, according to new research out of Stockholm, Sweden.  Read further for the right "dose" of chocolate.

Stockholm and Boston-based researchers investigated over a thousand people who had suffered a first heart attack, surveying them about chocolate consumption over the year prior to the heart attack, then followed their course over the next eight years.

The more chocolate consumed, the risk of dying from heart disease gradually lessened: up to 65% less than those who never ate chocolate.

Now, this is no reason to go hog-wild on chocolate.  We're not talking about mountains of chocolate.  The categories of consumption in the survey were 1) never, 2) less than once a month, 3) up to once a week, and 4) twice or more per week.  The "twice or more per week" people had the lowest risk of dying from heart disease over the eight years after their first heart attack. 

Maybe "twice or more per day" would be even healthier, but I doubt it.

Flavonoids are chemicals in chocolate, especially dark chocolate, that have strong antioxidant properties.  This may be the source of the health benefits.

If we look at the ability of dark chocolate to reduce C-reactive protein levels (a marker of systemic inflammation), the healthy dose of dark chocolate may be quite small: no more than 20 grams every three days, and perhaps quite a bit less. 

The Stockholm researchers didn't break down chocolate intake into dark versus milk chocolate.

If you're a heart attack patient, it's probably a good idea to eat chocolate. Check with you doctor.  Regarding the best "dose," twenty grams of dark chocolate twice a week is as good an estimate as any.

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

References: 

Janszky, I., et al.  Chocolate consumption and mortality following a first e\acute myocardial infarction: the Stockholm Heart Epidemiology Program.  Journal of Internal Medicine, 266 (209): 248-257.

Di Giuseppe, Romina, et al.  Regular Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population.  Journal of Nutrition, 138 (2008): 1,939-1,945.

Higher Whole Grains, Lower Blood Pressure

Whole grain consumption is linked to lower risk of high blood pressure in men, according to the current issue of American Journal of Clinical Nutrition. 

Harvard researchers studied over 31,000 men in the Health Professionals Follow-Up Study over the course of 18 years.  At the time of enrollment in the study, the men were free of high blood pressure.  Over 18 years, 9,200 developed high blood pressure.

Compared with men eating the very least amount of whole grains, the men in the highest consumption category had a 19% lower rate of high blood pressure. 

The Womens' Health study found evidence for a similar anti-hypertensive action of whole grains in women.

A meta-analysis published last year looked at whole grain consumption and cardiovascular disease, which includes heart attacks and strokes.  Compared with low intake, people with high intake (2.5 servings a day) had 21% lower risk of cardiovascular disease events, such as heart disease, stroke, and death from cardiovascular disease.  Refined grain intake, such as standard white bread, was not associated with cardiovascular disease one way or the other.

These associations of whole grain consumption and lower cardiovascular disease rates don't prove the whole grains prevent cardiovascular disease.  Proof would require a 10-year study involving 20,000 people, half of whom are forced to eat whole grains, and the other half must abstain.  I'm not holding my breath;  I'm inclined to eat whole grains now.

Very often we have to make food decisions before we have all the information we'd like.

For those interested, I've also written about unusual diet modifications to lower blood pressure, and, of course, the DASH diet for lowering blood pressure. 

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

References: 

Flint, Alan, et al.  Whole grains and incident hypertension in men.  American Journal of Clinical Nutrition, 90 (2009): 493-498.

Mellen, Philip, et al.  Whole grain intake and cardiovascular disease: A meta-analysis.  Nutrition, Metabolism & Cardiovascular Diseases, 18, (2008): 283-290.

Do You Worry Too Much About Heart Disease, Or Not Enough?

The American Heart Association offers a free, anonymous, online calculator that give you a rough idea of your chance of a heart attack or dying from heart disease over the next 10 years.

That should settle the question in the headline.

I've used it to help motivate my patients who seem a bit too lackadaisical about their health, especially the ones with multiple risk factors for heart disease.  I'm not talking about the 20-year-old at the peak of fitness and health, but the 40-year-old overweight, sedentary, smoker with a scary family history of premature heart disease.

You'll get the most accurate results from the calculator if you know your numbers:  blood pressure, cholesterols (total, HDL, LDL), triglycerides, blood sugar level, height, weight, and waist circumference.

The health assessment tool is designed for people 20 or older who don't already have heart disease, diabetes, or atherosclerosis of the arteries in the neck or legs.  People with type 2 diabetes can use a similar risk assessment tool: My Diabetes Health Assessment.

NutritionData stands ready to help you, in concert with your personal health professional, with heart disease risk factor modification.  Click the following links for details:

• Overweight
• High blood pressure
• Smoking
• Physical inactivity
• Poor diet
• Type 2 diabetes

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.