20/20 InSights

August 2008 - Posts

• Moderation Monday

  Apparently some people in the supplement industry are up in arms about a B-vitamin study showing that supplemental B vitamins did not reduce risk of cardiovascular events or death. Of course, this response isn't surprising coming from industry, but some of their criticisms are amusing.  Dr. Daniel Fabricant criticized the study's exclusion criteria, saying that many of the study's subjects were taking beta blockers (drugs that help control blood pressure) or statins (drugs that help control cholesterol) at the same time. Dr. Fabricant, this shouldn't matter.  This is what randomization is all about.  If you randomly assign your subjects to the treatment or placebo (which was done in this study), the two groups will balance themselves out.  In fact, in a summary report of the study here, it states, "the groups did not differ significantly regarding age, gender, clinical, laboratory or angiographic findings, cardiovascular risk factors or concomitant medication". Supplemental B-vitamins have been pushed in the past because they are known to lower homocysteine.  Homocysteine is a protein in the blood that has been found to be correlated with heart disease; the higher your homocysteine level, the higher your risk of disease.  However, this doesn't necessarily mean that homocysteine causes heart disease.  In fact, this study, along with many others, have failed to show any benefit from lowering homocysteine levels with B vitamin supplementation. As I mentioned in another blog, we tend to get a little bit crazy in our society when it comes to vitamin/mineral supplementation.  We automatically think more is better (although more could actually be worse).  We expect that taking a multivitamin/mineral is going to stop us from getting cancer or heart disease or some other terrible condition.  But that's not the purpose of a multivitamin/mineral.  Really, the reason to take a multivitamin/mineral is more as a safeguard against potential deficiencies.  This means the doses don't need to be very high.  Doses near the RDA should be more than adequate in a multivitamin (with some exceptions, like vitamin D). Remember, everything in moderation....       Posted Aug 25 2008, 02:30 PM by jkrieger with no comments

• Hungry Decisions

  There's a good article over on FoodNavigator on how hunger causes us to make bad decisions in regards to eating.  You can read the article here. Here's a good excerpt:  “When individuals extend the interval between meals or consume more of their food away from home, they are significantly more likely to consume more calories and more calories from solid fats, alcohol, and added sugars (discretionary calories) at each eating occasion. “For example, going five hours between meals instead of four adds about 52 calories for someone on a diet of 2,000 calories per day; extending that interval from four to six hours would add about 91 calories to the meal. Going longer stretches between meals is also estimated to lower diet quality at each meal.” This adds to the body of evidence that frequent, small meals (5-6 per day) is important in hunger control and weight management.  The longer you go without eating, the more calories you'll end up eating at a meal, and the less likely you'll make good choices at that meal.  I know, for myself, if I go to the grocery store hungry, I'm much more likely to buy foods that I normally would never buy.  Or, if I go too long without eating, I'll make less healthy choices at my subsequent meal.  You can reach this "I'm so hungry I don't care what I eat" state. Anyone want to share their experiences related to this subject?  What are your strategies for avoiding this?  With our busy lifestyles, it can be easy to fall into these traps.   Posted Aug 21 2008, 09:44 AM by jkrieger with 1 comment(s)

• Insurance...for treatment or prevention?

  Back in 1999, I had a brief 3-month stint in cardiac rehab, working a lot with coronary artery bypass graft (CABG) patients. We had a Phase II and Phase III to our treatment.  Phase II was for clients soon after their discharge from the hospital, and typically lasted for 12 weeks.  It involved closely monitored aerobic exercise, along with some weight training and flexibility training. Phase III was a maintenance program for patients that had graduated from Phase II, and again involved closely monitored exercise, although at a lower frequency. Phase II was often covered by insurance, but Phase III wasn't.  I remember discussing with my colleagues about this how the insurance companies would save themselves money in the long run if they covered Phase III.  The importance of exercise in the prevention of future cardiovascular events (like heart attacks) is well documented in scientific studies.  But the insurance companies would only pay for the post-surgery rehab, which only gets patients "back on their feet" so to speak.  Often, the patients who did not continue to exercise after Phase II ended back up in the hospital at some point down the road, which obviously cost the insurance companies more money...probably more than they would've payed for an on-going prevention program. The reason I bring this up is because a colleague recently emailed me an article in the New York Times about weight loss camps for kids, and how they usually weren't covered by insurance.  Unfortunately, when they weren't covered by insurance, the families couldn't afford the programs. It's been well-established that childhood obesity leads to a host of health problems, and that more and more children are experiencing type 2 diabetes, a disease that only middle-to-older aged adults used to get.  The burden that these problems will place on our health-care system and on employers is tremendous.  For example, it's been estimated that a type 2 adult diabetic's health-care costs are 2.3 times greater than a person without diabetes.  In the long-run, insurance companies probably would save more money by paying for preventive programs rather than paying for the problems after they've already occurred. I'm interested in hearing your thoughts.  What do you think?  Do you think insurance companies should cover preventive programs?  If not, why not?  If so, what types of coverage would be fair?   Posted Aug 18 2008, 03:50 PM by jkrieger with 3 comment(s)

• Artificial/Natural Wars Episode III: Return of the Sweeteners

  A long time ago, in some blogs far, far away, I talked about how the line between artificial and natural is more like a fog rather than a line. I also talked about how natural ingredients aren't inherently any safer or better for us than artificial ingredients. I also mentioned how natural ingredients can be used to disguise what's really in a product. A recent experience I had shows this perfectly.  I had a meeting with the CEO of a beverage company planning to come out with a new drink.  The drink was sweetened with agave syrup, a sweetener that comes from the agave plant.  He made a big deal out of this, because agave syrup is a natural sweetener.  This drink was going to be marketed towards health & fitness-conscious people as a post-workout recovery drink. Agave syrup is big as a sweetener in health foods because of its "natural" label.  Health-conscious people like this as an alternative to sweeteners such as high-fructose corn syrup, which they don't consider natural.  Also, agave syrup is extremely sweet, much moreso than normal table sugar, meaning you don't need as much to get the same sweetness. However, what makes agave syrup so sweet is exactly what makes it unhealthy for you, despite its "natural" label. Agave syrup is almost 90% fructose.  Sweetening something with agavey syrup is like using pure crystalline fructose as a sweetener.  Fructose is almost 200% more sweet than regular table sugar.  It's the fructose content of agave syrup that makes it so sweet. But it's this high fructose content that makes agave syrup unhealthy.  Too much fructose in the diet is associated with a lot of health problems, including insulin resistance, metabolic syndrome, disruption of appetite regulation, fat formation in the liver, and high blood cholesterol and triglycerides.  It's estimated that the American diet is much, much too high in fructose. By comparison, high fructose corn syrup is only 55% fructose, and isn't much different from normal table sugar.  Thus, high fructose corn syrup is actually a healthier choice of sweetener than agave syrup, despite the fact that agave syrup is "natural". So, don't be fooled by "natural" labels.  Agave syrup is probably one of the worst sweeteners out there, even though it's "natural."   Posted Aug 15 2008, 12:00 PM by jkrieger with 2 comment(s)

• Monday Mix

  MORE D, LESS DEATH If you aren't already sick of me talking about vitamin D, well, I'm going to talk about it again. In a study in the Archives of Internal Medicine, researchers found that people who had the lowest blood levels of vitamin D had a 26% greater risk of death from any cause as compared to people with the highest levels.  This was a well-designed epidemiological study of over 13,000 people. The evidence is becoming overwhelming how important vitamin D is to your health.  Thus, it's extremely important that you consider getting your vitamin D levels tested by your doctor.  If your levels are low, then adequate sun exposure and vitamin D supplementation will probably be necessary.  Even if your levels are fine, getting some sun exposure and supplemental vitamin D is a good preventative measure.  Consider supplementing with a minimum of 1000 IU, and try to get 15-20 minutes of sun exposure to your hands, arms, and face about three times per week. -------------------------------------------------------------------------- RUN LONG, LIVE LONG  Vitamin D isn't the only thing that may help you live longer.  Another study in the Archives of Internal Medicine found that people who ran regularly had a 39% decreased risk of dying during old age than people who did not run.  The researchers looked at runners who ran about 4 hours per week in their 50's, and continued to run about 76-80 minutes per week into their 70's and 80's.  They compared the runners to controls who did not run. Another interesting aspect of this study was that the researchers found that the runners had less disability with old age.  Many people associate running with an increased risk of joint problems with age, but the researchers did not find this.  In fact, running delayed the onset of disability by about 16 years. The bottom line is that exercise truly is a miracle drug.  Nothing works better for slowing the effects of aging than exercise. ---------------------------------------------------------------------- SALT SENSITIVE? I used to be of the opinion that high salt intakes only increased blood pressure in people who were "salt sensitive."  However, a recent study indicates that I may have been wrong. In a study published in the American Journal of Clinical Nutrition, researchers looked at salt intake and people's genes.  The researchers looked at a special gene for angioitensinogen, a chemical in your body that is related to blood pressure control.  In this study of over 11,000 people, the researchers found that the effects of salt on blood pressure were not affected by a person's genotype.  People that had higher salt intakes and higher salt excretion in their urine had higher blood pressures, regardless of their genetics. While not salting your food can help reduce your salt intake, the best way is to simply avoid processed foods.  In fact, only 10% of your daily salt intake comes from salting your food.  Processed foods, like canned goods, soups, frozen meals, and deli meats are the real culprits.  These foods often have high sodium contents because of the flavor and because of the increase in shelf life.  Check the sodium content of the food labels, and talk to your dietitian if you have concerns that your sodium intake may be too high. Posted Aug 11 2008, 05:02 PM by jkrieger with 2 comment(s)

• Out-D-oor Exercise

  Summer months bring the sun.  Well, usually.  Yeah, we got off to a bad start to our summer here in the Northwest, but things have improved. Of course, even if we had a completely lame summer, summer months bring something else....travel.  Road trips and vacations are popular summer activities.  So you're bound to get some sun somewhere. In a past blog, I talked about vitamin D, and how sunlight is your most important source.  So whether you're on vacation or sticking around here in the summer, if you just get 15 minutes of sun exposure (without sunscreen) 2-3 times per week, you're getting a nice dose of D. This is particularly important if you're overweight, as people who are overweight are more deficient in vitamin D than people of normal weight. Since exercise is an important component of any weight loss program, you might want to consider doing your exercise outside during the summer months.  A recent study showed that overweight people who exercised outside were 47% less likely to be vitamin D deficient than people who didn't exercise outside. So, take advantage of your vacation or any sunny days you may get, and get some outdoor exercise in, especially if you're overweight. A good way to see if you're getting enough vitamin D is to have your doctor test you for your blood levels.  If your levels are deficient, you know you need to get more sun or may need to supplement. Those are my thoughts for this first week in August.  Forecast looks good, so I think I'm going to go grab myself some vitamin D :)   Posted Aug 11 2008, 04:57 PM by jkrieger with no comments