Category Archives: Uncategorized

Quality, not Quantity: the New Goal for Weight Loss

For years, we have heard over and over that our weight is tied to the amount of calories we eat. The prevailing wisdom was that if we could just reduce the calories taken in, then we could lose weight. More recently, we are starting to understand that the type of food we eat, not just a total calories, may be more important to our health. Now a major study confirms the concept.

These researchers, in a very careful and rigorous fashion, studied not just the total calories take it in, but also the quality and type of food eaten in a large group of test subjects whose weight, and overall health status, was tracked over a year. You can read the details of this extensive study here, but here are some of the key conclusions:

Dieters who cut back on added sugar, refined grains and other processed foods, while also increasing their intake of vegetables and whole foods successfully lost weight, regardless of total caloric intake.
This strategy applied equally to reducing fats or carbs, as neither strategy was clearly better.
The key point is that these dieters were not told to count calories, just focus on better quality selection of food, and they had successful weight loss and still actually reduced the total amount of calories a day. So this seems to confirm that quality, not quantity, is the key to a healthy diet.

For more articles on a heart-healthy diet, see our Diet page.

Does diet advice drive you nuts? Maybe it should drive you TO nuts. . . .

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We have known for a while that nuts are a natural source of good fats, vitamins, and healthy minerals. Doctors and other health experts (including the HeartHealth Docs) have recommended nuts as part of a balanced diet for some time, and they are an important part of the Mediterranean diet, which seems to have a lot of heart healthy benefits.

But a new study, which you may have seen reported in the media, is the most comprehensive to date to look specifically at the link between nuts and heart prevention. The researchers analyzed data from 3 very large population health studies, including over 200,000 healthy adults, who were followed for up to 30 years to look at incidence of heart disease and stroke. What did they find?

1. Participants who consumed at least 5 servings of nuts weekly had about a 14% lower risk of heart disease than those who never ate nuts.
2. The link was similar for those who ate peanuts, tree nuts, or walnuts.
3. Surprisingly, there was a preventive benefit for heart disease but less so for stroke (with exception of peanuts and walnuts, which did have a slight positive effect).
4. Other not products, such as peanut butter, did not seem to have a protective effect.

Like a lot of population studies, this one was retrospective, so it did not prove that there is a direct link between nut intake and reduced disease. And the groups studied were not ethnically diverse. But it was carefully performed and in a very large population, so it is the best evidence so far that nuts are part of a healthy prevention diet.

Take away messages:
1. 1-5 servings of nuts weekly can be an important component of a preventive diet, especially for those who have, or are at risk for, heart and vascular disease.
2. All type of notes seem to be beneficial, even peanuts which are technically a legume.

3. Because nuts have a lot of calories, portion sizes important. A serving of nuts is 1 ounce, which is about 28 peanuts, or 23 almonds.

4. Processed products such as peanut butter do not seem to have the same beneficial effect.

So find ways to incorporate whole nuts into your diet, but watch the portions!

Here is a link to more information about the study.

Here is more information from our site regarding diet and prevention.

Here are examples of a single serving of almonds:

Omega-3’s? Vitamin D? Vitamins? Which can prevent heart disease?

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With heart disease continuing to be a leading cause of death throughout the world, researchers continue to look at how diet, supplements and other habits can impact the development of heart disease. Here is a rundown of some new studies that continue to shed light on how to prevent (or in some cases, not prevent) heart disease:

As most doctors have suspected for a while, vitamin D seems to have minimal effect on your heart and circulation system. This new study seems to confirm that fact. Certainly, people with a severe deficiency should have replacement therapy, but routine use does not appear to have a significant preventive benefit.

The news with multivitamins is similar. We have suspected this for a while (see our prior article on the role of supplements) but now a large study on thousands of patients (in this case, limited to men) seems to confirm that routine multivitamin use really does not prevent future heart disease. This does not exclude other benefits, but reinforces our recommendation that multivitamins are probably not needed for those with a well-rounded diet.

How about fish oil? Here is a link to a nice updated article addressing which patients may benefit from omega-3 fatty acids. Despite high hopes, no studies have really shown a broad benefit to most healthy adults. But those with specific conditions may benefit.

These studies reinforce the Heart Health Doctors’ dietary advice – eat a balanced diet low in processed foods, unnecessary carbs (especially wheat-based) and saturated fats, and watch the total calories. As always, you should consult with your health provider about what specific diet is best for your health, and your medical conditions.

Here are our earlier articles on diet, supplements and heart disease:

Which Supplements Improve Wellness and Prevent Heart Disease?

Heart Healthy Diet – 10 eating tips

Do Healthy Adults benefit from Fish Oil?

You Really Are (and might die from) What You Eat (. . .or Don’t Eat)!

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Most of us understand that there is a link between what we eat and our health – but how strong, and how important, is that connection? Heart and circulatory disease is the number one killer of American adults, and we know that certain dietary behaviors can either promote, or reduce, health consequences.

But a new study just released, shows just how strong that association is between diet and heart disease. These researchers looked at all of the important studies of specific food types and disease associations, then compared this to national surveys of Americans’ eating habits. They then estimated what proportion was due these various dietary habits.

Overeating, or not eating enough, of the 10 foods and nutrients contributes to nearly half of U.S. deaths from heart and circulatory disease, the study suggests. bread

“Good” foods that were under-eaten include: nuts and seeds, seafood rich in omega-3 fats including salmon and sardines; fruits and vegetables; and whole grains.

“Bad” foods or nutrients that were over-eaten include salt and salty foods; processed meats including bacon, bologna and hot dogs; red meat including steaks and hamburgers; and sugary drinks.

Of course, this was a study of populations, and most of us are most concerned about our personal habits and risk of disease (remember, only your doctor or health care provider can give your specific advice about your health care). And most importantly, the fact that certain dietary habits are “associated” with bad health, doesn’t mean those foods “cause” bad health. But this is an interesting study that helps quantify the most important targets for change in our diet. (click here to read the full study)

For more information on Heart Health and Diet, see our overview article here.

Who Benefits from Fish, or Fish Oil? Some New Info on the Link to Heart Disease

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While we have known for some time about the potential benefits of fish in the diet, the specific role of supplements containing the beneficial component, omega-3 fatty acids, has been less clear, due to inconsistent results from various studies.

Fortunately, a new study released this month has clarified the link between supplementation with omega-3 fatty acids and the development of heart disease. This was actually a meta-analysis, meaning it summarized the data from multiple previous studies, in a manner that yields more information than the individual studies themselves. This was a very thorough analysis, specifically looking at the best quality studies (called randomized trials), and specifically looking at the useful component of omega-3 fatty acids, EPA and DHA. Moreover, the researchers were focused specifically on heart and circulatory complications.

What did they find? The intake of omega-3 fatty acids, either from food or supplements, fish-oil reduced the risk of heart disease by 6%. This reduction is mild, and was actually insignificant, but there was a significant decrease specifically patients who started out with high triglyceride levels (> 150 mg/dL) or LDL cholesterol (> 130 mg/dL). When the researchers included additional nonrandomized studies, the reduction in heart disease was 18%. Another important conclusion was that there does not appear to be any harmful effect of supplementation.

So what can we conclude?
First, supplementation with 1 g of omega-3 fatty acids daily, either from food or supplements, appears to be mildly beneficial in preventing heart and circulatory disease.
Second, the majority of the benefit is in patients who start out with elevation of triglyceride or LDL cholesterol. Previous studies (such as this) have shown that otherwise healthy patients derive minimal or no benefit from fish oil supplementation.
Third, there does not appear to be evidence of harm at this level of supplementation.

Also of note, more detailed studies are ongoing to determine the optimal level of supplementation and specific patients. Finally, keep in mind that there are other potential benefits of fish oil supplementation unrelated to heart disease, so if supplementation makes you feel better or healthier, it may be reasonable. As always you should discuss your specific health situation with your doctor before considering any supplement or other therapy.

For more information, here as a video I recorded last year for the video blogging site Vidoyen.com, who asked me, Do Fish Oil supplements prevent heart disease? Here is a link to my 3 minute reply.

Reference to original article:

Alexander D, Miller P, Van Elswyk M, et al. A meta-analysis of randomized trials and prospective cohort studies of eicosapentaenoic and docosahexaenoic long chain omega-3 fatty acids and coronary heart disease risk. Mayo Clin Proc 2017;92:15-29

Interested in heart health information?

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The Heart Health Doctors site is here to help people improve their heart and circulation health through education.

There is a lot of health information on the internet – a great resource to check for up to date discussions on research is the Topic Archive for the ongoing blog from Women’s Health Research at Yale called ‘Help with the Headlines,’ http://medicine.yale.edu/whr/news/heart/archive/

Topics include diet, exercise, caffeine, stress, and depression and effects on heart health. The format is question & answer, for non-cardiologist readers to learn about their heart health. Check back to the Help with the Headlines site for my comments on an August 2016 study that showed new findings about heart disease risk factors for women.

Each issue can be downloaded – the most recent post looks at whether loneliness and social isolation can lead to heart disease.

http://medicine.yale.edu/whr/news/heart/hearthealth.aspx

Are “Bad” Fats Still Bad? Some New Information

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We often receive conflicting information on the role of dietary fats and heart risk. A new bread study released this month is attempting to clarify this link, since it is one of the largest studies ever conducted on dietary fats and overall long-term health risk. It was performed by the well-respected Harvard School of Public Health, and used a database of over 126,000 men and women followed for 32 years. These were healthcare workers who are in good health, and the dietary habits were followed closely with detailed questionnaires. Their rates of death over 32 years were then tracked carefully.

Here are some of the key findings:
1. Eating more saturated fat and trans-fats (“Bad” fats) was indeed associated with an increase in overall mortality (death rates).
2. Eating more polyunsaturated and mono unsaturated fats (“good” fats) did reduce the overall risk of death. For example, replacing just 5% of your total calories of bad fats with good (polyunsaturated) fats, would reduce the risk of death by 27%.
3. Simply replacing the bad fats with carbohydrates did not show any protective effect. (I call this the “Snackwell Cookie” effect)
4. In addition to lower heart and vascular disease, subjects who ate more healthy fats also had a lower risk of dying from neurodegenerative and respiratory disease. So, a healthy diet may protect against a variety of chronic diseases.

Polyunsaturated fats contain essential fats your body can’t produce by itself, such as omega-6 and omega-3 fatty acids. Some of the best sources are nuts, seeds, fatty fish, and leafy greens. They are also found and vegetable oils such as canola, soybean, and safflower oil. In this particular study, monounsaturated fats were also protective but less so than polyunsaturated fats. The most common example of a monounsaturated fat is olive oil.

Of course, this was a retrospective review, so the findings are not as powerful as a randomized study. Nevertheless, the study appears to support the recommendation that we should reduce saturated fats in our diet, and emphasize polyunsaturated fats instead. We should also be careful not to increase our carbohydrate intake to compensate, emphasizing the role of total calories. We still have a lot to learn regarding the optimal diet for disease prevention, but studies like this continue to shed light on the subject.

MORE INFORMATION:

This article from CNN Online has a very nice summary of the findings, along with an excellent summary of the various types of good and bad fat, and examples of each in the diet: Good fats can cut risk of death by 27% @CNN

Here is a link to the scientific summary of the study:

Is Butter really “Back”? Not exactly. . . .

Low Fat or Low Carb? A new study sheds some light. . . .

Surprise Sources of Salt in Your Diet

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Most of us are familiar with high-salt foods on our diet – but for those of us who have high blood pressure, or are just trying to minimize sodium intake to maintain a healthy lifestyle (which is certainly advocated by the HeartHealth Doctors) – our best intentions can be undone by hidden sources or sodium, especially in processed foods from the grocery store, as well as fast-food and restaurant-prepared items. Here is a useful article with graphics that illustrates some of the common “culprits” that contain unexpectedly high amounts of salt.

According to the article, the average American adult consumes 3,400 milligrams of sodium a day — more than 1,000 milligrams more than the recommended daily allowance of 2,300 milligrams. While this guideline is critical for those with hypertension (high blood pressure) , it is more controversial whether healthy adults benefit from strictly watching their sodium intake. However, since sodium intake seems to directly affect our blood pressure, which is turn if elevated can lead to elevated risk for strokes and heart attacks over time, it is probably prudent for all adults (and children) to minimize “extra” or unnnecessary sodium in the diet.

For more information, as well as online resources, about high blood pressure, click here for our previous article. This article also has information on the optimal diet for those with hypertension, the “DASH” diet.

Another Reason to “Stand Up” to Heart Disease!

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In case you need another excuse to get off the couch (and think about a treadmill desk). . . it appears “too much sitting” may in itself contribute to the progression of heart plaque. . .

Too Much Sitting May Up Risk of Coronary Artery Calcification

Marlene Busko

SAN DIEGO, CA — Each added hour spent sitting was associated with a 14% increase in coronary artery calcium (CAC) score, independent of traditional risk factors, including physical activity, in a study of middle-aged subjects without cardiovascular disease^[1].

“Our study contributes to the growing body of evidence whereby health consequences of ‘sitting too much’ appear to be distinct from those of ‘too little exercise,’ and [it] suggests that increased subclinical atherosclerosis may be one of the mechanisms through which sedentary behavior increases CV risk,” Dr Jacquelyn Kulinski (Medical College of Wisconsin, Milwaukee) told heartwire from Medscape.

The researchers examined data from 2031 participants in theDallas Heart Study who were aged 20 to 76, with a mean age of 50. Just over half (62%) were women, and about 50% were black.

Participants had a CT scan to measure CAC; a CAC score above 10 was deemed positive and a score below 10 was deemed negative. In addition, the participants wore a watch accelerometer for at least 4 days to measure body movements, which were classed as sedentary, light activity (nonexercise), or moderate to vigorous physical activity.

On average, participants were sedentary for 5.1 hours a day, but this ranged from 1.1 to 11.6 hours a day. Older people, those with a higher body-mass index (BMI), and those with diabetes or hypertension were more likely to spend more time sitting.

After adjustment for BMI, systolic blood pressure, total cholesterol, HDL cholesterol, statin use, type 2 diabetes, smoking, household income, education, marital status, employment, and moderate to vigorous physical activity, each hour of sedentary time was associated with a 10% higher odds of having CAC (adjusted odds ratio 1.10, 95% CI, 1.01–1.21; P=0.035).

Moderate to vigorous physical activity was modestly associated with CAC in models adjusted only for age, gender, and ethnicity, but the association disappeared after adjustment for traditional cardiovascular risk factors, including smoking, diabetes, BMI, cholesterol, and blood pressure, Kulinski added. Even though study participants exercised only an average of 6 minutes a day, other studies in marathon runners have also reported that exercise was not associated with CAC, she noted.

LINK TO FULL ARTICLE:

Too Much’ Sitting May Worsen Coronary Calcification, Regardless of Exercise
Heartwire from Medscape, 2015-03-11

The Heart Health Doctors

Promoting heart and circulatory wellness through education

Category Archives: Uncategorized

Quality, not Quantity: the New Goal for Weight Loss

Does diet advice drive you nuts? Maybe it should drive you TO nuts. . . .

Omega-3’s? Vitamin D? Vitamins? Which can prevent heart disease?

You Really Are (and might die from) What You Eat (. . .or Don’t Eat)!

Who Benefits from Fish, or Fish Oil? Some New Info on the Link to Heart Disease

Interested in heart health information?

The Heart Health Doctors site is here to help people improve their heart and circulation health through education.

There is a lot of health information on the internet – a great resource to check for up to date discussions on research is the Topic Archive for the ongoing blog from Women’s Health Research at Yale called ‘Help with the Headlines,’ http://medicine.yale.edu/whr/news/heart/archive/

Are “Bad” Fats Still Bad? Some New Information

Surprise Sources of Salt in Your Diet

Another Reason to “Stand Up” to Heart Disease!

In case you need another excuse to get off the couch (and think about a treadmill desk). . . it appears “too much sitting” may in itself contribute to the progression of heart plaque. . .

Too Much Sitting May Up Risk of Coronary Artery Calcification

Top articles from our first 2 years. . .