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Category: Nutrition

“Eat your breakfast! It’s the most important meal of the day!” -Your Mom (and Science).

First your mom told you, and now, science is nodding—your mom is always right.

A link between skipping breakfast and poor cardiovascular health has now been researched and proven.

A recent study1 consisted of 4,052 middle-aged female and male participants with no previous history of cardiovascular disease. The study researchers also collected information on the cholesterol levels, physical activity, body mass index, and smoking status of all study participants. All participants were told to take note of what they had eaten along with the specific times they had eaten these items.

Imaging techniques were used to study the buildup of fatty material in the arteries around the heart and neck. Compared to those participants who consumed more than 20% of their daily calories at breakfast time, the participants who had tiny breakfasts or who skipped breakfast altogether, were found to have a greater extent of artery buildup which means their risk of heart attacks and strokes is increased.

Sub-clinical atherosclerosis (the buildup of fat) was found in 75% of those who skip breakfast Even when high blood pressure, smoking or other factors were taken into account, the link between skipping breakfast and poor cardiovascular health was evident throughout the study results.

What was interesting aside from JUST skipping breakfast, the participants who were breakfast skippers were also more likely to lead a lifestyle that was unhealthy overall. These breakfast skippers also maintained a poor diet, were usually smokers, and found to drink alcohol frequently. “Perhaps skipping breakfast is not what is to blame for heart disease. It seems to be a poor lifestyle that is causing the heart disease; and simultaneously also making people MORE likely to skip out on breakfast.”

In conclusion, healthier people are more likely to actually eat breakfast.

What the researchers in this study found is that people who skipped breakfast were likely doing so in an unhealthy way in order to lose weight. This would explain why the rate of obesity was higher in those who skipped breakfast. Apparently, the breakfast skipping caused an odd consumption of calories at strange times during the day and disrupted a good “pattern of eating.”

The study participants will be followed for 10 more years in order to determine how arterial disease progresses, with the hope that we could glean a better idea of this link between poor cardiovascular health and skipping the first meal of the day.

The question is really not only about whether you are a breakfast eater or breakfast skipper. It is really about how that choice begins your path to other choices for healthy options during the rest of your 24 hours!

If you are trying to be healthy or to actually lose weight, you should keep an eye on your consumption but be diligent as to what food you are eating throughout your day; instead of trying to get rid of a meal (or calories) in the beginning of the day. It’s never a good idea for us to skip our meals, so do yourself a favor and eat at regular times. Listen to your mom!

Do you have patients that skip meals? Do YOU skip meals as a busy practitioner?
If you are interested in CME education on cardiovascular health and how to get YOUR patients some more help with their nutrition and lifestyles, visit us at CMHC West in May!

1Metro.co.uk. Scott, Ellen. http://metro.co.uk/2017/10/03/people-who-skip-breakfast-could-have-an-increased-risk-of-heart-disease-6972641/. October 3, 2017. Accessed October 26, 2017
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Eating your way OUT of a heart attack

A couple days ago, we shared the difference between a cardiac arrest and a heart attack with you.
We also shared that even though they are different things, they do share the SAME risk factors.
What we want to share with you today, is the good news: many of these risk factors can be eliminated.

The Facts

According to the CDC, every year about 735,000 Americans have a heart attack.1

“Heart disease needs urgent intervention. And that intervention, it is increasingly getting clear, has to be a lifestyle and diet makeover” according to Kenneth Thorpe, chairman at Partnership to Fight Chronic Disease (PFCD).2

But I’m young…

Studies have noted a marked increase in the number of young patients suffering from heart attacks.

A recent article shared a story about a 29-year-old marketing and sales professional who had suffered a heart attack. He had no family history of a heart attack.

What they did report however was that this patient’s lifestyle included heavy smoking, not enough exercise, and that he was overweight. In 2011, this same patient had a second heart attack, followed by a third in 2013. He failed bypass surgery, and ended up undergoing a heart transplant in August last year at the young age (in our opinion) of 45 years old.

In the past year, he has lost approximately 70 pounds. Abhay Singh, was 205 lbs. at the time of his first heart attack. Before his heart transplant he shot up to 253lbs.

Mr. Singh, now 46 years old and 182 lbs., leads a normal life. However, it is a different life from before.

He has to exercise every day, drink and smoke minimally, not eat as much salt, and also must keep a close eye on his lipid profile.

Listen to your body

At 29 years old, Mr. Singh thought his first heart attack was just indigestion.

When he finally got to the doctor 12 hours later, his heart had sustained significant damage.

Manage your DIET
A study published in the Journal Of The American Medical Association (JAMA) in March 2017 shows that a large percentage of deaths due to cardiovascular disease and diabetes are linked to a poor diet.

According to the study, 10 foods/nutrients associated with cardiometabolic diseases are fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats (refined oils, hydrogenated fats, etc.), sugar-sweetened beverages (SSBs), polyunsaturated fats (PUFA), seafood omega-3 fats and sodium.

NO MORE SALT
Excess sodium intake (too much salt) was connected to the highest proportion of heart disease (it was associated in 9.5% of deaths). It has been proven that high-salt diets increase blood pressure and the risk of heart disease extensively. Research (3) has found that those of us who consumed more than 13.7g of salt daily had a two times higher risk of heart failure compared to those who consumed less than 6.8g. “The World Health Organization recommends a maximum of 5g per day.” says Dr. Sundeep Mishra, professor of cardiology, All India Institute of Medical Sciences (AIIMS). Scary but true, the majority of us ingest more than 10 times the amount of salt we need to meet our sodium requirements.

Other top-of-the-list dietary patterns affecting heart health were low intake of nuts and seeds (8.5%), high intake of processed meats (8.2%) and low fruit and vegetable intake (7.6 and 7.5%, respectively).

What this proves is that diet matters when it comes to heart disease.

GOOD fat?
Apparently, not all fats are bad, and the kind of fat we eat is a big deal.

“Saturated and trans fats increase blood cholesterol and heart attack rates. PUFA (Polyunsaturated fatty acids) and monounsaturated (MUFA) fats lower the risk of heart attacks,” according to Dr. Simmi Manocha, head of department, non-invasive cardiology, Asian Institute of Medical Sciences, Faridabad.

Most of us have heard of Omega-3’s and apparently they are a type of PUFA that is really beneficial for cardiovascular health. Want proof?

Both plant-based and seafood-based omega-3 lower the risk of fatal heart attacks by about 10% according to a study by Tufts University, US. The researchers also found that Fish, walnuts and flaxseed oil are the best sources of omega-3.

Are you an apple or a pear?

So according to all of the above, we learned that a poor diet is bad for the heart.

A bad diet can lead to weight gain, and even if you are otherwise considered healthy, gaining weight raises the risk of heart attack by over a quarter!

Even if you have healthy blood pressure, blood sugar and cholesterol levels, being overweight or obese increases your risk of coronary heart disease (CHD) by up to 28% compared to those with a healthy bodyweight, according to a study published in the European Heart Journal.

A person who carries the bulk of their body fat around their stomach (an “apple” shaped body) is at greater risk of heart disease than someone whose body fat tends to settle around their bottom, hips and thighs (a “pear” shaped body) according to Dr. Manocha.

SUMMARIZE:

  • Avoid packaged foods
  • Avoid salt
  • Take Omega 3’s
  • Stick to natural, minimal processed foods like nuts or fruits – remember PUFA & MUFA (Polyunsaturated fatty acids and monounsaturated)
  • Keep an eye on your weight (avoid an apple shape)
  • Manage your lifestyle – don’t overdo drinking; try to stop smoking
  • Listen to your body (see a doctor immediately if you feel warning signs)
  • Get educated (that’s where we come in)…

At CMHC, we try to bring the latest science and research in the cardiometabolic space to physicians and allied health professionals like you. Every one of you treats heart health or deals with the risk factors listed in this article. Most of all, we try to get you the most robust education that ties all of this research into what can help YOUR patients, today. A few years ago, we launched CMHC West and are so excited to take it to Las Vegas next year from May 4-5, 2018.

Our 2018 agenda will capture the integrity and high-quality education of the annual CMHC event (that just wrapped up in Boston) as the top U.S. experts in cardiometabolic health will highlight the latest updates in heart failure, diabetes, hypertension, cardiovascular health and lifestyle management. Invest in your education and visit us in Las Vegas – register for only $99 until December 31 when the price increases!

Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-322.
LiveMint. Are you eating your way to a heart attack? http://www.livemint.com/Science/6UgERyTXiXXdSAgJomm6kL/Are-you-eating-your-way-to-a-heart-attack.html. September 26, 2017. Accessed October 13, 2017.
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The Benefits of a Vegan Diet

While there are a multitude of promises available regarding specific diets that will help individuals lose weight and/or mitigate cardiovascular risks factors, clinical research indicates that within a few weeks of eating a whole-food, plant-based diet, many people will have improved insulin sensitivity and lowered levels of cholesterol.


Dr. Thomas M. Campbell, Medical Director of the T. Colin Campbell Center for Nutrition Studies and clinical director of the University of Rochester Program for Nutrition Medicine, also refers to the high probability of improved bowel movements, enhanced sleep hygiene and increased energy, and improved skin quality.

Extensive scientific literature and research demonstrates that dietary cholesterol and saturated fat are linked to a heightened risk of cardiovascular disease. Meat and fish have saturated fat, while a vegan diet is devoid of any cholesterol, and low in terms of saturated fat. When people begin to eat a plant-based diet, therefore, their cholesterol levels decline; and ultimately, their risk of cardiovascular disease decreases. This all happens within a few weeks, as blood vessel walls become healthier due to the increase of nitric oxide in arterial walls, which reduces the risk for heart attacks and strokes. Moreover, without heavy saturated fats from animal products, blood is less viscous and begins to pump more easily at lower pressures.

The American Diabetes association confirms that among individuals with type 2 diabetes, those who eat a vegan diet have considerably improved glycemic control, in addition to lessened cardiovascular risk factors. The diet can even reverse the disease altogether, in some patients. According to Dr. Michael Klaper, an internationally-recognized authority on the link between diet and health, “A person with uncontrolled diabetes, on insulin, can see demonstrable improvements in medication usage and efficacy in 24 hours.” Conversely, another study also published by the American Diabetes Association indicates that those who eat high amounts of animal protein are 22 percent more likely to develop diabetes.

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Biomarkers Could Predict Best Diets

A new study, published in the American Journal of Clinical Nutrition, has indicated two biomarkers that can predict the efficacy of certain diets for weight loss: specifically, for people with prediabetes or diabetes.

Through an analysis of over 1,200 adults, researchers discovered that a person’s fasting blood glucose levels, fasting insulin levels, or both, could pinpoint which diets would most likely lead to weight loss. These biomarkers were particularly effective in determining which diets were best for people with pre-diabetes and diabetes.

Each year, millions of us go on diets in an attempt to lose weight, but not all of us succeed. A new study has uncovered two biomarkers that could predict how effective certain diets will be for weight loss, particularly for people with prediabetes or diabetes.

Statistics from the American Diabetes Association indicate that approximately 29.1 million people in the Untied States have diabetes; estimates show that around 75 million people have pre-diabetes, yet almost 90% remain unaware. Type 2 diabetes is the most common form of the condition: the body is unable to effectively use the hormone insulin, which causes high blood glucose levels. For people with prediabetes, blood glucose levels remain higher than normal—yet not high enough to lead to a diagnosis of diabetes.

The researchers in the study believe that a person’s fasting blood glucose and insulin levels could be utilized to help identify the most effective diet for weight loss, after analyzing the data of three dietary clinical trials: the Diet, Obesity, and Genes trial, the OPUS Supermarket intervention (SHOPUS), and the Nutrient-gene interactions in human obesity (NUGENOB) trial. The subjects were all overweight; the researchers evaluated and assessed their fasting blood glucose levels, and fasting insulin levels, in order to determine whether the levels were associated with weight loss in response to certain diets.

These results symbolize a kind of breakthrough in personalized nutrition: among adults with prediabetes, the team found that a diet rich in whole grains, vegetables, and fruits was the most effective for weight loss. For example, in the SHOPUS trial, adults with prediabetes who followed a diet high in the aforementioned foods lost more weight than those who followed a controlled diet. For people with type 2 diabetes, the researchers found that a diet rich in plant-based, “healthy” fats, and low in carbohydrates, was most effective for weight loss.

The team reported that adding participants’ fasting insulin levels to the analysis further strengthened the identified correlations between diet and weight loss, confirming the hypothesis that fasting blood glucose and fasting insulin levels may be biomarkers for weight loss.

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The Benefits of Mindful Eating

Recent studies indicate that meal timing and frequency may impact cardiovascular health, and disease risks. While eating patterns vary from person to person, research indicates that effective management of cardiometabolic health should focus on ‘intentional eating’–paying attention to standardize eating times, meal sizes, and food content.

One of the primary critical factors in evaluating the effect of meal frequency and timing on cardiovascular health was what constituted a meal that potentially impacted metabolism. Data shows that distributing calories over a defined period of the day, coupled with maintaining a consistent overnight fast period, could ultimately yield positive benefits surrounding cardiometabolic health–in addition to eating a larger portion of one’s daily caloric intake earlier in the day.

Skipping meals and snacking, which have become increasingly prevalent, have various effects on cardiometabolic health markers: namely obesity, lipid profile, insulin resistance, and blood pressure. Because irregular eating patterns do not lead to a healthy cardiometabolic profile, intentional eating–with mindful attention to the timing and frequency of eating occasions–will lead to a healthier lifestyle. Most importantly, planning each meal with a variety of healthy foods, and timing meals, can help manage hunger, achieve desired portion control, and improve nutrition quality.

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Coconut Oil: Not So Healthy?

 A recent new advisory report from the American Heart Association advises against the use of coconut oil, a popular trend in the health and wellness industry.

The Dietary Fats and Cardiovascular Disease, after viewing existing data on saturated fats, has demonstrated that coconut oil specifically increased LDL—known as ‘bad’ cholesterol—in seven out of seven controlled oils. 82% of the fat in coconut oil is saturated, according to data: exceeding butter, beef fat, and pork lard.

The advisory stated: “Because coconut oil increases LDL cholesterol, a cause of cardiovascular disease, and has no known offsetting favorable effects, we advise against the use of coconut oil.” Marie-Pierre St-Onge, associate professor of nutritional medicine at Cornell University Medical School, believes that coconut oil is so popular for weight loss due to her research on medium-chain triglycerides. Because coconut oil has a higher proportion of medium-chain triglycerides than most other fats or oils, and her research indicated that medium-chain triglycerides may increase the rate of metabolism, many now believe that coconut oil can be responsible for weight loss.

However, St-Onge’s research used a ‘designer oil’ that was full of 100% medium-chain triglycerides; traditional coconut oil only contains about 13-15%. Moreover, another study published by St-Onge reveals that smaller doses of medium-chain triglycerides does not help with weight loss in overweight adolescents.

“You can put it on your body, but don’t put it in your body,” said Frank Sacks, lead author on the report.

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Most Cardiologists Lack Nutrition Education

A recent study has found that the majority of cardiologists lack current, up-to-date education surrounding nutrition and diet. A report published by the American Journal of Medicine, authored by a dozen healthcare professionals in the United States and Spain, titled “A Deficiency of Nutrition Education and Practice in Cardiology” details that less than a third of cardiologists describe their nutrition knowledge as “mostly up to date” or better.

Although the leading cause of premature death and disability in the United States is heart disease, most cardiologists report inadequate training in nutrition. “Using nutrition as medicine is probably one of the most cost effective ways to treat disease but is incredibly underutilized by healthcare providers,” explained Andrew Freeman, M.D., a cardiologist at National Jewish Health in Denver, and one of the study’s co-authors. “If we could empower healthcare providers with information on how to implement this in daily practice, we could transform healthcare rapidly, prevent healthcare cost explosions, and reduce morbidity and mortality.”

Ninety percent of cardiologists surveyed reported receiving no or minimal nutrition education during cardiovascular fellowship training; 59 percent reported no nutrition education during international medicine training; 31 percent reported no nutrition education throughout medical school. Almost two-thirds of all surveyed cardiologists reported spending three minutes or less per visit discussing nutrition with their patients.

The report further noted that the total annual cost related to heart and vascular diseases in the United States is $315 billion, much of which could be lessened with proper nutritional training and implementation.

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Calling All Cheese Lovers

A large-scale analysis indicates that cheese, and other dairy products, do not lead to an increased risk of death from heart disease or stroke.

A study published in the European Journal of Epidemiology involving scientists at the Institute for Food, Nutrition, and Health at the University of Reading, England analyzed 29 studies that collectively represented almost 1 million people and 93,000 instances of death.

Within the studies, the team focused on diet—specifically, whether or not participants consumed large amounts of dairy products—and the rates of CVD, coronary heart disease, and death.

The conclusions and findings showed no correlation or association between a diet high in dairy and risk of heart disease, combining data from 29 prospective cohort studies.

One of the study’s authors, Jing Guo, stated that this latest analysis provides “further evidence that a diet high in dairy foods is not necessarily damaging to health.” The evidence supports previous findings that demonstrate the health benefits of dairy foods in an integrated, well-balanced diet.

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Vitamin D: A Necessary Supplement!

A new study reports that in overweight and obese children and adolescents, a deficiency of vitamin D is associated with early markers of cardiovascular disease.

Lead author Marisa Censani, M.D., pediatric endocrinologist and director of the Pediatric Obesity Program in the Division of Pediatric Endocrinology at New York Presbyterian Hospital/Weill Cornell Medicine, states that “Pediatric obesity affects 17 percent of infants, children, and adolescents ages 2 to 19 in the United States, and obesity is a risk factor for vitamin D deficiency.”

The findings suggest that deficiency of the vitamin may have negative effects on specific lipid markers, with an increase in cardiovascular risk among children and adolescents. This is one of the first studies to assess the relationship of vitamin d deficiency to both lipoprotein ratios and non-high density lipoprotein cholesterol, specific lipid markers impacting cardiovascular risk during childhood, in children and adolescents who are obese or overweight.

Vitamin D was found to be significantly associated with an increase in atherogenic lipids and markers of early cardiovascular disease. Total cholesterol, triglycerides, LDL, non-HDL cholesterol, as well as total cholesterol/HDL and triglyceride/HDL ratios, were all higher in vitamin D-deficient patients—compared to patients without vitamin D deficiency.

The results support screening children and adolescents who are overweight or obese for vitamin D deficiency, and the potential benefits of improving vitamin d status to reduce cardiometabolic risk.

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What to Eat…and What NOT to Eat

A recent report indicates that ten foods account for nearly half of all heart disease deaths in the United States. Researchers at Tufts Friedman School of Nutrition and Policy found that if people ate less salt and meat, and ate more nuts, fruits, and vegetables, they could greatly lower the risk of heart disease.

The researchers at Tufts developed their list of preferred foods from national surveys, which covered 16,000 people from 1999-2012. Volunteers filled out food diaries, and were tracked for several years subsequently, to see what had happened with their health. In 2012, the team wrote that over 700,000 Americans died of cardiovascular disease. Of these deaths, an estimated 45 percent were associated with ‘suboptimal intakes of the 10 dietary factors,’ states the report—published in the Journal of the American Medical Association.

The team used previously published studies surrounding the benefits or drawbacks of each of the 10 foods, in order to determine how much each one contributes to the risk of death from heart disease. Their calculations suggest that eating too much sodium accounted for 9.5 percent of the deaths; eating too few nuts accounted for 8.5 percent of the deaths; eating too much processed meat accounted for 8.2 percent of the deaths; and eating too little seafood was responsible for 7.8 percent of the deaths.

For decades, the American Heart Association has stressed that food is a critical factor in preventing the country’s primary cause of death. Many studies have previously demonstrated that Americans eat far too much meat, cheese, processed grains, sugar, and salt. Studies also confirm the health effects of the consumption of a daily handful of nuts, in addition to eating more vegetables, fruits, and whole grains; diets rich in these foods also lower the risk of cancer, diabetes, and Alzheimer’s disease. This study’s results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.

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