Disheartening Love Handles

While a beer gut may be unsightly, studies suggest tummy fat is even harder on the heart than on the eyes.

The visceral (or deep) flab of a pudgy midsection hugs vital organs in the abdomen, which stresses their function. It also strains the circulatory system, spurs inflammation, and inhibits insulin production, bumping up your chances for developing cardiovascular disease and diabetes. Studies even link belly blubber to higher breast cancer risk.

Help deflate your spare tire with these easy tips:

  • Cut back on the trans–fats, sugar, and alcohol. One study found that trans–fats are more inclined to settle in your stomach, likely because your body is stumped on what to do with them. And because they promote insulin resistance, trans–fats slow your body’s fat distribution process, so more gets stockpiled. Sugar has a similar effect, while alcohol tampers with the torso’s calorie–burning efforts.
  • Step up your aerobics. Fortunately, your highly metabolic love handles are some of the first deposits to respond to fat–burning exercise, so start getting at least 30 minutes a day of walking, jogging, or biking.
  • Eat whole grains and drink water. One study found that eating whole grains helped slim down the waistline. And because drinking plenty of water keeps you hydrated and may lessen your craving for high calorie thirst–quenchers, you reap the benefits of adding fewer calories while providing your body with essential fluid.

Low Vitamin D: A Global Concern

Recent studies suggest that vitamin D is much more important in fighting off disease than previously thought. Being deficient in this vitamin puts one at risk of diseases such as cancer, osteoporosis, and multiple sclerosis. Chances are that if you live in a northerly geographic region you do not get enough vitamin D. Persons who live a rather sedentary lifestyle and do not get outside for at least a 15-minute daily walk in the sun are in the same position. Latinos, African-Americans and others with dark skin tend to have much lower levels of vitamin D, as do people who are overweight or obese. All around the world millions of persons suffer from vitamin D deficiency. This phenomenon is so common that it affects persons on every continent, of all ethnic groups, and across all ages. Some surveys suggest that perhaps half of the world’s population has inadequate blood levels of vitamin D. Sadly, physicians, even in industrialized countries, are seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification.

As with most research findings, there is plenty of debate. Indeed, as opposed to what many people think, there are few certainties in science; its nature is to be open to criticism, discussion, and revision. The Institute of Medicine (IOM) released a report in November 2010 which recommends a daily vitamin D intake of 600 IU per day, for people ages 1 to 70, and 800 IU, for people over age 70—the report referred to persons living in the U.S. and Canada. The report also recognized the safety of vitamin D by increasing the upper limit from 2,000 to 4,000 IU per day, and acknowledged that even at 4,000 IU per day, there was no good evidence of harm.

Some in the scientific community believe the new guidelines are too conservative about the intake, and that they do not give due consideration to the latest findings about vitamin D and health. They contend that the new guidelines are not enough to prevent chronic disease, and they are not sufficient to help those who have problems with their bones. This is an important debate, and in order to understand it better it is necessary to know the origins of vitamin D and how it functions in the human body.

Vitamin D Sources and Function

Our body makes vitamin D and it is also a nutrient we eat. The body produces vitamin D from cholesterol, which itself is triggered by sun lighting on the skin. Yet many persons do not make enough vitamin D from the sun, persons with darker skin, those who are overweight, and persons who use products that block sunlight being among them. Correctly applied sunscreen reduces our ability to absorb vitamin D by more than 90 percent.

To be sure, not all sunlight is of the same quality and intensity: The sun’s ultraviolet B (UVB) rays—the so-called “tanning” rays, and the rays that trigger the skin to produce vitamin D—are stronger near the equator and weaker at higher latitudes. Indeed, persons who live in places prone to considerable cloudiness and rain can suffer from vitamin D deficiency. The other way we get vitamin D is to eat food that contains a lot of it. However, few foods are naturally rich in vitamin D, so the biggest dietary sources of vitamin D are fortified foods and vitamins supplements.

Vitamin D helps the body absorb and retains calcium and phosphorus, which are critical elements for building bone. Laboratory studies show that vitamin D can reduce cancer cell growth, can increase muscle strength, and can help control infections. There may yet be other functions for vitamin D, and scientists continue to explore the many other uses for this important substance.

New Vitamin D Research: Beyond Building Bones

Vitamin D research has proved to be of considerable fecundity. Although there have been many reports issued over the years, there are only a few that offer enough evidence to constitute a clear medical breakthrough. Here we provide the more promising areas of vitamin D research, highlighting the complex role of vitamin D in disease prevention—and the many unanswered questions that remain.

Vitamin D and Bone and Muscle Strength

A number of random trials have shown that high doses of vitamin D supplements help reduce bone fractures. A summary of the evidence comes from a combined analysis of 12 fracture prevention trials that included more than 40,000 elderly people, most of them women. Researchers found that high intakes of vitamin D supplements—of about 800 IU per day—reduced hip and non-spine fractures by over 20 percent, while lower intakes (400 IU or less) failed to offer any fracture prevention benefit.

It has been shown that vitamin D may also help increase muscle strength, which can help prevent elderly persons from falling, a common problem that leads to increased rates of disability and death among them. A combined meta-analysis found that taking 700 to 1,000 IU of vitamin D per day lowered the risk of falls by 19 percent; the combined studies also show that taking 200 to 600 IU per day offered no such protection. Based on this data, the International Osteoporosis Foundation recommends that adults over age 60 maintain vitamin D blood levels of 30ng/ml. This means that most people will need vitamin D supplements of at least 800 to 1,000 IU per day, and possibly higher, to reach these levels.

Vitamin D and Heart Disease

The heart, as a skeletal muscle, is a receptor of vitamin D. A number of studies have found that lack of vitamin D is linked to heart disease. The Health Professional Follow-Up Study observed the vitamin D blood levels in nearly 50,000 men who were healthy. They followed the same group for 10 years and found that men who were low in vitamin D were twice as likely to have a heart attack as men who had adequate levels of vitamin D. Other studies have linked low vitamin D levels to an increased of heart failure, sudden cardiac death, stroke, overall cardiovascular disease, and cardiovascular death. There is some evidence that vitamin D plays a vital role in controlling blood pressure and preventing artery damage. This goes some ways in explaining the findings above. However, more research is needed before a sounder conclusion can be made.

Vitamin D and Cancer

Nearly 30 years ago, researchers discovered an interesting correlation between colon cancer deaths and geographic location. They found that people who lived at higher latitudes, such as in the northern U.S. or Canada, had higher rates of death from colon cancer than people who lived closer to the equator. The sun’s UVB rays are weaker at higher latitudes, and in turn, people’s vitamin D levels in these high latitude locales tend to be lower. Researchers formed the hypothesis that vitamin D deficiency can lead to an increased risk for getting colon cancer

Some time has passed, but dozens of studies suggest a relationship does exist between low vitamin D levels and increased risks of colon and other cancers. The evidence is strongest for colorectal cancer, with observational studies have found that persons with lower vitamin D levels are at higher risk of getting such diseases. Vitamin D levels may also predict cancer survival, but there is as yet little evidence to support this. However, it is not yet certain that taking vitamin D supplements necessarily lowers the risk of contracting cancer. This latter idea will be tested in the VITAL trial. The VITAL trial will look specifically at whether vitamin D supplements lower cancer risk. However, it is likely to be years before the trial produces any results. Additionally, the VITAL trial could fail to detect a real benefit of vitamin D. There are several reasons for this. First, if people in the placebo group decide to take their own vitamin D supplements, the differences between the placebo group and the supplement group could be minimized. Second, the study may not follow participants for a long enough time to show a cancer prevention benefit; or study participants may be starting supplements too late in life to lower their cancer risk.

In any case, given the evidence now on hand, 16 scientists have circulated a “call for action” on vitamin D and cancer prevention. Given the high rates of vitamin D inadequacy in North America, the strong evidence for reduction of osteoporosis and fractures, the potential cancer-fighting benefits of vitamin D, and the low risk of vitamin D supplementation, these scientists recommend vitamin D supplementation of 2,000 IU per day. The Canadian Cancer Society has also recommended that Canadian adults consider taking vitamin D supplements of 1,000 IU per day during the fall and winter. They also recommend that people who are at high risk of having low vitamin D levels because of old age, dark skin, or geographic location take vitamin D supplements year round.

B Vitamins and Heart Disease

Can B vitamins keep your heart healthy?

Sadly, the death of two young children who had died of massive strokes were the catalyst for a 1968 investigation. The Boston pathologist who investigated the death of the children found that they had extraordinarily high levels of a protein breakdown product in their blood. Both children’s arteries were blocked by cholesterol as well, resembling more closely the arteries of a middle-aged unhealthy person than those of a young child. These discoveries led to the hypothesis that elevated levels of this breakdown product (know as homocysteine) had contributed to the process of hardening of the arteries. This condition is called atherosclerosis. So, what is the connection between B vitamins and heart health?

Folate, vitamin B6 and vitamin B12 are instrumental in the body’s ability to convert homocysteine into methionine. Methionine is one of the 20 substances that help the body to build new proteins. Insufficient levels of any or all of these B vitamins can hamper the conversion process, driving homocysteine levels up. Sufficient levels of these vitamisn, on the other hand, can help to keep homocysteine at a safe level.

Many studies over the last few decades have shown that high levels of homocysteine can be associated with an increase in the risk of heart disease and stroke. Some studies have also shown that there is a causal relationship between high intakes of folate and the lower incidence of cardiovascular disease, hypertension and strokes. There cannot be a direct link made, however, between higher homocysteine levels and lower folate levels to an increased risk of heart disease. In other words, it cannot be definitely stated that lower homocysteine levels by taking more folic acid and other B vitamins will lower one’s risk of having a heart attack, stroke or other heart-related condition.

There have been several randomized trials involving B vitamins and heart health, but they have not conclusively shown any relationship between the two. In the studies adutl participants who had a history of heart conditions or who were in the upper risk categories for heart disease were given either a placebo or a pill that contained high doses of vitamins B6, B12 and folic acid. The result of the study was that taking the high doses of the three B vitamins did lower the levels of homocysteine present in the body, but that that reduction did not lead to a reduction in the number of cardiac events in the participants. There is some suggestion that the participants in this study were already too far gone in terms of heart health for the B vitamins to have an effect.

Recently, analysis of several studies seems to suggest that taking folic acid supplements can reduce the likelihood of a stroke in a person who had never before suffered a stroke. The risk reduction does not occur, however, in people who have already had a stroke. Further, folic acid was most effective in promoting heart health when combined with vitamins B6 and B12 as opposed to when it is consumed in isolation.

In the United States and in Canada, since the governments in those countries have mandated that certain products such as bread and pasta be fortified with folic acid, the rate of death from stroke has fallen dramatically. In the UK, where folic acid fortification is not yet mandated, there has been no significant change in the rate of death from strokes.

The long and the short of it is this: Folic acid supplementation may reduce the risk of heart disease in people who have lower levels of folate in their systems. This will typically include those people living in countries where folic acid fortification of food is not yet the rule. In countries where people already get adequate levels of folic acid from their food, further supplementation, even levels that are much higher than can be found in a standard multivitamin, has not been sufficiently shown to be of any significant benefit and, actually, may cause harm.

Currently, what constitutes a sufficient daily intake of B vitamins isn’t clearly defined. The definition would likely change over time anyway, as more data are collected from randomized trials. Currently in the United States, folic acid fortification of food has led to an increase in the percentage of adults who have adequate levels of folate in their systems. Still, only a small percentage of American adults currently get the recommended daily intake of all B vitamins derived just from their diets alone.

Get Your Fiber

Older adults who eat cereals with high fiber or dark breads may be helping to improve their heart health, shows new research.

Researchers from the University of Washington analyzed data from more than 3,500 adults, ages 65 and older, who participated in the Cardiovascular Health Study. Participants did not have cardiovascular disease at the start of the study and provided their diet information throughout the study.

Researchers identified more than 800 new cases of cardiovascular disease at the eight-year follow-up. Results of the study show adults who ate a high amount of cereals high in fiber had a 21-percent lower risk of cardiovascular disease compared to adults who ate the lowest levels of cereal fiber. Researchers found no link between fruit or vegetable intake and cardiovascular disease. Dark breads, such as wheat, rye and pumpernickel, also lowered the risk of cardiovascular disease.

Authors of the study write, “While the observed difference in risk was not large, it was seen with a fairly modest difference in dietary intake, approximately equal to two slices of whole grain bread per day. Compared with medical or surgical interventions, nutritional changes are relatively low risk, low cost, and widely available.”

According to the study, there are currently 35 million people over age 65 in the United States. Researchers say this is the fastest growing segment of the population and by the year 2030, 70 million people will be over age 65. Cardiovascular disease is the leading cause of death and disability among older adults.

SOURCE: Journal of the American Medical Association, 2003;289:1659-1666

Understanding your blood pressure for diabetes

Myth “You know if you have high blood pressure because it gives you headaches”

Truth High blood pressure does not always give you symptoms, and it is often found by chance during routine health checkups. Having your blood pressure checked at your annual diabetes reviews, and more frequently if your health professional suggest it, will be a more reliable indicator of whether your blood pressure is high.

My doctor tested me for Type 2 diabetes because I am having treatment for high blood pressure. Why is that?

Type 2 diabetes and high blood pressure are both linked to insulin resistance, so if you have one of these conditions it is common to have the other, too. If you keep both your blood pressure and your blood glucose level under control, your chances of developing long-term complications, especially heart disease, are greatly reduced.

What is high blood pressure?

If your larger blood vessels become more rigid and your smaller blood vessels start to constrict, your blood has to flow through a narrower space than before. The result is greater pressure on your blood vessel walls, which is known as high blood pressure or, medically, as hypertension. Having high blood pressure is common when you have Type 2 diabetes.

I have high blood pressure but I don’t feel sick. Why does it need to be treated?

Having high blood pressure makes you much more prone to cardiovascular disease (CVD) – a serious condition that develops over many years as your blood vessels gradually become narrower and less flexible. You may have high blood pressure without knowing it and, if it remains untreated, you may develop angina (severe chest pain) or have a heart attack or a stroke. Taking your blood pressure treatment as prescribed and having regular checkups can help prevent these serious conditions.

What should my blood pressure be?

If you have Type 2 diabetes your blood pressure should be below 130/80 millimeters of mercury (mmHg). In some situations, for example if you have already developed kidney damage (nephropathy), you may need to keep your blood pressure lower, for example, 125/75 millimeters of mercury (mmHg) to prevent further damage. Discussing your ideal blood pressure level, and ways to achieve it, with your health professional will give you the level that is right for you.

Why are there two figures in my blood pressure measurement?

The top figure refers to the level of pressure in your blood vessels as your heart contracts and pumps blood around your body. This is known as the systolic blood pressure. The second figure is the lowest pressure as your heart relaxes between beats. This is known as the diastolic blood pressure.

What can I do to lower my blood pressure?

Stop smoking and lose weight if you need to, eating more fresh fruit and vegetables and less saturated fat and salt (for example, less processed or commercially prepared meals) to help reduce your blood pressure. Physical activity will also lower your blood pressure. Take any blood pressure pills that you have been prescribed, even if they do not affect the way you feel, to help keep your blood pressure in the recommended range.

How low can my blood pressure go?

It would be unusual for your blood pressure to be under 100/60 mmHg if you are otherwise healthy. For every 10 mmHg drop in your systolic blood pressure (the first figure) toward this level, you benefit by reducing your risk of heart attack or stroke.

New Insight Into Cardiovascular Disease

A seldom-measured amino acid that is circulating in your blood may be an indication of cardiovascular disease. It is called homocysteine, and an increasing number of physicians and researchers are acknowledging that high levels of the chemical are associated with heart disease and stroke.

A summary of 15 studies revealed that elevated homocysteine levels produced a 70 percent increase in the risk of coronary artery disease and a greater risk for stroke. Previous studies have shown connections with schizophrenia, Alzheimer’s disease, hypothyroidism and anemia.

However, the evidence is not conclusive. “Five other studies found no link between homocysteine and cardiovascular disease,” says Oklahoma City internist Dr. E. Randy Eichner, a member of the Editorial Board of The Physician and Sportsmedicine, “but six studies did find a relationship. I think the balance of scientific evidence favors a homocysteine/CAD link.”

Atlanta cardiologist Dr. John Cantwell agrees with Eichner. “I recognize it as a possible risk factor, but the only time I measure it is when a person has a family history of heart disease without the more obvious risk factors.”

Dr. M. Rene Malinow, professor of medicine at the Oregon Health Sciences University and one of the nation’s leading homocysteine researchers, says we don’t yet know for sure that it is a cause of atherosclerosis. “We will have to wait for the results of clinical trials, and that could take several years.” Adds Malinow, “Although it is a relatively new risk factor by itself, it is possible that a high homocysteine level combined with traditional risks, such as hypertension or smoking, is even more significant.

Even those who think homocysteine is related to heart disease are not sure why it may have a harmful effect. One theory is that, in elevated amounts, it irritates the inner lining of the arteries and could cause blood clots to form. There is even a possibility that homocysteine levels increase after a stroke, not before.

Prevention

The good news is that a high homocysteine count can be prevented or treated by getting adequate amounts of folic acid (folate). Cantwell tells patients who have high levels to take 0.4 mg of folic acid per day, as well as a multivitamin supplement that includes B6 and B12. A high intake of folate by itself can mask other medical conditions, including a type of anemia.

The U.S. Food and Drug Administration has mandated that all enriched grain products be fortified with folate. Check the labels on cereal boxes. Most of them provide 25 percent of the daily folate requirement and many contain 25-35 percent of daily vitamin B6 and B12 needs. If you are eating a well-balanced diet, you probably don’t need the supplements.

Screening

Homocysteine screening is not very common. The American Heart Association is taking a very conservative position on the issue, saying that it’s too early to recommend general screening. Cantwell points out that the one-year cost of a folate and multivitamin supplement is approximately equal to the cost of a screening test.

Americans are well informed of the risk factors associated with heart disease. Sooner or later, a new one — elevated homocysteine levels — may be added to that list.

Folate is also good for unborn babies.