From: www.newsweek.com
By Dean Ornish M.D
What really works to make sustainable changes in diet and lifestyle? It's probably not what you think. In over 30 years of conducting clinical research, I've learned that the real keys are pleasure, joy and freedom, not willpower, deprivation and austerity. Joy of living is sustainable; fear of dying is not.
Why? Because life is to be enjoyed. There's no point in giving up something you enjoy unless you get something back that's even better, and quickly. When people eat more healthfully, exercise, quit smoking, manage stress better, and love more, they find that they feel so much better, so quickly, it reframes the reason for making these changes from fear of dying (too scary) or risk-factor modification (too boring) to joy of living. Fortunately, the latest studies show how dynamic and powerful are the mechanisms that control our health and well-being. When you exercise and eat right:
Your brain receives more blood flow and oxygen, so you become smarter, think more clearly, have more energy, and need less sleep. Two studies showed that just walking for three hours per week for only three months caused so many new neurons to grow that it actually increased the size of people’s brains!
Your face receives more blood flow, so your skin glows more and wrinkles less. You look younger and more attractive. In contrast, an unhealthy diet, chronic emotional stress and smoking reduce blood flow to your face so you age more quickly. Smoking accelerates aging because nicotine causes your arteries to constrict, which decreases blood flow to your face and makes it wrinkle prematurely. This is why smokers look years older than they really are and often have a gray pallor. Supermodel Christy Turlington, whose father died of lung cancer, has a wonderful Web site, which is a powerful antidote to the idea that smoking is beautiful.
Your sexual organs receive more blood, so you become more potent—this is how drugs like Viagra and Levitra work—but without the costs and side effects. In contrast, unhealthy lifestyle choices often lead to impotence. For example, half of men who smoke are impotent. Cigarettes are marketed in ways that make it seem as though you'll be sexy and beautiful, but they really make you ugly and impotent—how sexy is that?
Your genes change. In May, my colleagues and I at the nonprofit Preventive Medicine Research Institute and the University of California, San Francisco, published a study in the Proceedings of the National Academy of Sciences showing that changing your lifestyle changes your genes. Really. After only three months of following the lifestyle program described in my book, "The Spectrum," the expression of over 500 genes changed in men with early-stage prostate cancer. We found that genes associated with cancer, heart disease and inflammation were downregulated or "turned off" whereas protective genes were upregulated or "turned on." Craig Venter's pioneering work showed that one way to change your genes is to synthesize new ones. Our research is showing that another way to change your genes is to change your lifestyle.
Your telomeres get longer. Telomeres are the ends of our chromosomes that control how long we live. As telomeres become shorter, then cells age and die more quickly. In simple terms, as your telomeres get shorter, your life gets shorter.
Chronic emotional stress shortens your telomeres. My colleagues, Elissa Epel and Elizabeth Blackburn of the University of California, San Francisco, conducted a pioneering study of mothers who were caring for a child with a chronic illness. They found that the more stress the women reported experiencing, the shorter their telomeres. Women with the highest levels of perceived stress had telomeres shorter on average by the equivalent of at least one decade of additional aging compared to low-stress women.
One of the most interesting findings in this study was that the mothers' perceptions of stress were more important than what was objectively occurring in their lives. The researchers gave the women a questionnaire and asked them to rate on a three-point scale how stressed they felt each day, and how out of control their lives felt to them. The women who perceived that they were under heavy stress had significantly shortened and damaged telomeres compared with those who felt more relaxed. Conversely, some of the women who felt relaxed despite raising a disabled child had more normal-appearing telomeres.
In other words, if you feel stressed, you are stressed.
I wondered: if chronic stress can decrease telomerase (an enzyme that repairs and lengthens telomeres) and cause telomeres to age more quickly, could healthy lifestyle changes prevent this from occurring? It did. A few months ago, my colleagues and I (including Blackburn) published a study in The Lancet Oncology showing that the telomerase enzyme increased by almost one-third after only three months of making comprehensive lifestyle changes. This was the first study showing that any intervention, even drugs, can increase telomerase and, thus, telomere length. If a new drugs were shown to do this, it would be worth a billion dollars, but you can accomplish this benefit virtually for free, and in only three months, simply by changing your lifestyle.
So, knowing that what was once thought impossible can now be accomplished in only a few months may capture our imaginations and be a powerful motivator to make sustainable lifestyle changes. For many people, these are choices worth making—not just to live longer, but also to feel better.
Tuesday, January 27, 2009
Saturday, January 24, 2009
Some Healthy Recommendations
From: www.health.gov
PHYSICAL ACTIVITY
Key Recommendations
Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight.
To reduce the risk of chronic disease in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week.
For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration.
To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements.
To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity.
Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.
Key Recommendations for Specific Population Groups
Children and adolescents. Engage in at least 60 minutes of physical activity on most, preferably all, days of the week.
Pregnant women. In the absence of medical or obstetric complications, incorporate 30 minutes or more of moderate-intensity physical activity on most, if not all, days of the week. Avoid activities with a high risk of falling or abdominal trauma.
Breastfeeding women. Be aware that neither acute nor regular exercise adversely affects the mother's ability to successfully breastfeed.
Older adults. Participate in regular physical activity to reduce functional declines associated with aging and to achieve the other benefits of physical activity identified for all adults.
FOOD GROUPS TO ENCOURAGE
Key Recommendations
Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 21/2 cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level.
Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.
Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.
Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.
Key Recommendations for Specific Population Groups
Children and adolescents. Consume whole-grain products often; at least half the grains should be whole grains. Children 2 to 8 years should consume 2 cups per day of fat-free or low-fat milk or equivalent milk products. Children 9 years of age and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.
FATS
Key Recommendations
Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible.
Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.
Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils.
Key Recommendations for Specific Population Groups
Children and adolescents. Keep total fat intake between 30 to 35 percent of calories for children 2 to 3 years of age and between 25 to 35 percent of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
CARBOHYDRATES
Key Recommendations
Choose fiber-rich fruits, vegetables, and whole grains often.
Choose and prepare foods and beverages with little added sugars or caloric sweeteners, such as amounts suggested by the USDA Food Guide and the DASH Eating Plan.
Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.
SODIUM AND POTASSIUM
Key Recommendations
Consume less than 2,300 mg (approximately 1 tsp of salt) of sodium per day.
Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.
Key Recommendations for Specific Population Groups
Individuals with hypertension, blacks, and middle-aged and older adults. Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg/day) with food.
ALCOHOLIC BEVERAGES
Key Recommendations
Those who choose to drink alcoholic beverages should do so sensibly and in moderation—defined as the consumption of up to one drink per day for women and up to two drinks per day for men.
Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions.
Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.
PHYSICAL ACTIVITY
Key Recommendations
Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight.
To reduce the risk of chronic disease in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week.
For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration.
To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements.
To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity.
Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.
Key Recommendations for Specific Population Groups
Children and adolescents. Engage in at least 60 minutes of physical activity on most, preferably all, days of the week.
Pregnant women. In the absence of medical or obstetric complications, incorporate 30 minutes or more of moderate-intensity physical activity on most, if not all, days of the week. Avoid activities with a high risk of falling or abdominal trauma.
Breastfeeding women. Be aware that neither acute nor regular exercise adversely affects the mother's ability to successfully breastfeed.
Older adults. Participate in regular physical activity to reduce functional declines associated with aging and to achieve the other benefits of physical activity identified for all adults.
FOOD GROUPS TO ENCOURAGE
Key Recommendations
Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 21/2 cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level.
Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.
Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.
Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.
Key Recommendations for Specific Population Groups
Children and adolescents. Consume whole-grain products often; at least half the grains should be whole grains. Children 2 to 8 years should consume 2 cups per day of fat-free or low-fat milk or equivalent milk products. Children 9 years of age and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.
FATS
Key Recommendations
Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible.
Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.
Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils.
Key Recommendations for Specific Population Groups
Children and adolescents. Keep total fat intake between 30 to 35 percent of calories for children 2 to 3 years of age and between 25 to 35 percent of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
CARBOHYDRATES
Key Recommendations
Choose fiber-rich fruits, vegetables, and whole grains often.
Choose and prepare foods and beverages with little added sugars or caloric sweeteners, such as amounts suggested by the USDA Food Guide and the DASH Eating Plan.
Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.
SODIUM AND POTASSIUM
Key Recommendations
Consume less than 2,300 mg (approximately 1 tsp of salt) of sodium per day.
Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.
Key Recommendations for Specific Population Groups
Individuals with hypertension, blacks, and middle-aged and older adults. Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg/day) with food.
ALCOHOLIC BEVERAGES
Key Recommendations
Those who choose to drink alcoholic beverages should do so sensibly and in moderation—defined as the consumption of up to one drink per day for women and up to two drinks per day for men.
Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions.
Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.
Mediterranean Diet
From: www.americanheart.org
What is the "Mediterranean" diet?
There's no one "Mediterranean" diet. At least 16 countries border the Mediterranean Sea. Diets vary between these countries and also between regions within a country. Many differences in culture, ethnic background, religion, economy and agricultural production result in different diets. But the common Mediterranean dietary pattern has these characteristics:
high consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
olive oil is an important monounsaturated fat source dairy products,
fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
eggs are consumed zero to four times a week
wine is consumed in low to moderate amounts
Does a Mediterranean-style diet follow American Heart Association dietary recommendations?
Mediterranean-style diets are often close to our dietary recommendations, but they don’t follow them exactly. In general, the diets of Mediterranean peoples contain a relatively high percentage of calories from fat. This is thought to contribute to the increasing obesity in these countries, which is becoming a concern.
People who follow the average Mediterranean diet eat less saturated fat than those who eat the average American diet. In fact, saturated fat consumption is well within our dietary guidelines.
More than half the fat calories in a Mediterranean diet come from monounsaturated fats (mainly from olive oil). Monounsaturated fat doesn't raise blood cholesterol levels the way saturated fat does.
The incidence of heart disease in Mediterranean countries is lower than in the United States. Death rates are lower, too. But this may not be entirely due to the diet. Lifestyle factors (such as more physical activity and extended social support systems) may also play a part.
Before advising people to follow a Mediterranean diet, we need more studies to find out whether the diet itself or other lifestyle factors account for the lower deaths from heart disease. See the Lyon Diet Heart Study entry in this Guide for more information.
Related AHA publications:
Easy Food Tips for Heart-Healthy Eating (also in Spanish)
"How Can I Cook Healthfully?" and "How Do I Follow a Low-Fat Diet?" in Answers By Heart kit (also in Spanish kit) See also:Dietary Recommendations for Healthy ChildrenFatFats and OilsMeat, Poultry and FishMilk ProductsObesity and OverweightOverweight in ChildrenStep I , Step II and TLC DietsVegetables and FruitsVegetarian Diets
What is the "Mediterranean" diet?
There's no one "Mediterranean" diet. At least 16 countries border the Mediterranean Sea. Diets vary between these countries and also between regions within a country. Many differences in culture, ethnic background, religion, economy and agricultural production result in different diets. But the common Mediterranean dietary pattern has these characteristics:
high consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
olive oil is an important monounsaturated fat source dairy products,
fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
eggs are consumed zero to four times a week
wine is consumed in low to moderate amounts
Does a Mediterranean-style diet follow American Heart Association dietary recommendations?
Mediterranean-style diets are often close to our dietary recommendations, but they don’t follow them exactly. In general, the diets of Mediterranean peoples contain a relatively high percentage of calories from fat. This is thought to contribute to the increasing obesity in these countries, which is becoming a concern.
People who follow the average Mediterranean diet eat less saturated fat than those who eat the average American diet. In fact, saturated fat consumption is well within our dietary guidelines.
More than half the fat calories in a Mediterranean diet come from monounsaturated fats (mainly from olive oil). Monounsaturated fat doesn't raise blood cholesterol levels the way saturated fat does.
The incidence of heart disease in Mediterranean countries is lower than in the United States. Death rates are lower, too. But this may not be entirely due to the diet. Lifestyle factors (such as more physical activity and extended social support systems) may also play a part.
Before advising people to follow a Mediterranean diet, we need more studies to find out whether the diet itself or other lifestyle factors account for the lower deaths from heart disease. See the Lyon Diet Heart Study entry in this Guide for more information.
Related AHA publications:
Easy Food Tips for Heart-Healthy Eating (also in Spanish)
"How Can I Cook Healthfully?" and "How Do I Follow a Low-Fat Diet?" in Answers By Heart kit (also in Spanish kit) See also:Dietary Recommendations for Healthy ChildrenFatFats and OilsMeat, Poultry and FishMilk ProductsObesity and OverweightOverweight in ChildrenStep I , Step II and TLC DietsVegetables and FruitsVegetarian Diets
Low-Carbohydrate Diet May Treat Obesity and Diabetes
From: www.newsmax.com
A low-carbohydrate diet may help treat obesity and diabetes say researchers at UT Southwestern Medical Center. A clinical study found that people on low-carbohydrate diets burn more liver fat than those on low-calorie diets, therefore fighting diseases such as diabetes, insulin resistance and nonalcoholic fatty liver disease.
“Instead of looking at drugs to combat obesity and the diseases that stem from it, maybe optimizing diet can not only manage and treat these diseases, but also prevent them,” said Dr. Jeffrey Browning, assistant professor in the UT Southwestern Advanced Imaging Research Center and of internal medicine at the medical center.
Glucose (a form of sugar) and fat are sources of energy that are metabolized in the liver and used as energy by the body. Glucose can be made from lactate, amino acids or glycerol. Too much fat in the liver can lead to nonalcoholic fatty liver disease (NAFLD) a condition that may affect as many as a third of all American adults. NAFLD is linked to metabolic disorders such as insulin resistance and diabetes. It can also lead to inflammation of the liver, cirrhosis and liver cancer.
Researchers gave overweight or obese patients either a low-calorie or low-carbohydrate diet. After two weeks, they used imaging techniques to analyze what techniques the body used to make glucose.
“We saw a dramatic change in where and how the liver was producing glucose, depending on diet,” said Dr. Browning, the study’s lead author. Those on the low-carbohydrate diet produced more glucose from lactate or amino acids than those on a low-calorie diet. Those on low-calorie diets got about 40 percent of their glucose from glycogen, but those on low-carbohydrate diets got only about 20 percent of their glucose from glycogen. Instead, low-carb dieters burned liver fat for energy.
“Energy production is expensive for the liver,” said Dr. Browning. “It appears that for the people on a low-carbohydrate diet, in order to meet that expense, their livers have to burn excess fat.
Results also indicate that those on low-carbohydrate diets increased the amount of fat burned throughout their entire bodies.
Even though the study wasn’t designed to determine which diets worked best to control weight, patients on the low-carb diet lost almost twice as much weight as those on a low- calorie diet.
Editor's Note:
Diabetes is Epidemic. Protect Yourself
A low-carbohydrate diet may help treat obesity and diabetes say researchers at UT Southwestern Medical Center. A clinical study found that people on low-carbohydrate diets burn more liver fat than those on low-calorie diets, therefore fighting diseases such as diabetes, insulin resistance and nonalcoholic fatty liver disease.
“Instead of looking at drugs to combat obesity and the diseases that stem from it, maybe optimizing diet can not only manage and treat these diseases, but also prevent them,” said Dr. Jeffrey Browning, assistant professor in the UT Southwestern Advanced Imaging Research Center and of internal medicine at the medical center.
Glucose (a form of sugar) and fat are sources of energy that are metabolized in the liver and used as energy by the body. Glucose can be made from lactate, amino acids or glycerol. Too much fat in the liver can lead to nonalcoholic fatty liver disease (NAFLD) a condition that may affect as many as a third of all American adults. NAFLD is linked to metabolic disorders such as insulin resistance and diabetes. It can also lead to inflammation of the liver, cirrhosis and liver cancer.
Researchers gave overweight or obese patients either a low-calorie or low-carbohydrate diet. After two weeks, they used imaging techniques to analyze what techniques the body used to make glucose.
“We saw a dramatic change in where and how the liver was producing glucose, depending on diet,” said Dr. Browning, the study’s lead author. Those on the low-carbohydrate diet produced more glucose from lactate or amino acids than those on a low-calorie diet. Those on low-calorie diets got about 40 percent of their glucose from glycogen, but those on low-carbohydrate diets got only about 20 percent of their glucose from glycogen. Instead, low-carb dieters burned liver fat for energy.
“Energy production is expensive for the liver,” said Dr. Browning. “It appears that for the people on a low-carbohydrate diet, in order to meet that expense, their livers have to burn excess fat.
Results also indicate that those on low-carbohydrate diets increased the amount of fat burned throughout their entire bodies.
Even though the study wasn’t designed to determine which diets worked best to control weight, patients on the low-carb diet lost almost twice as much weight as those on a low- calorie diet.
Editor's Note:
Diabetes is Epidemic. Protect Yourself
Tuesday, January 20, 2009
Very low Fat and Cholesterol Diet
From: http://www.heartattackproof.com/
I don’t want my patients to pour a single thimbleful of gasoline on the fire. Stopping the gasoline puts out the fire. Reforming the way you eat will end the heart disease.Here are the rules of my program in their simplest form:
• You may not eat anything with a mother or a face (no meat, poultry, or fish).
• You cannot eat dairy products.
• You must not consume oil of any kind—not a drop. (Yes, you devotees of the Mediterranean Diet, that includes olive oil, as I’ll explain in Chapter 10.)
• Generally, you cannot eat nuts or avocados.
You can eat a wonderful variety of delicious, nutrient-dense foods:•
*All vegetables except avocado. Leafy green vegetables, root vegetables, veggies that are red, green, purple, orange, and yellowand everything in between
• All legumes—beans, peas, and lentils of all varieties.
• All whole grains and products, such as bread and pasta, that are made from them—as long as they do not contain added fats.
• All fruits.
I don’t want my patients to pour a single thimbleful of gasoline on the fire. Stopping the gasoline puts out the fire. Reforming the way you eat will end the heart disease.Here are the rules of my program in their simplest form:
• You may not eat anything with a mother or a face (no meat, poultry, or fish).
• You cannot eat dairy products.
• You must not consume oil of any kind—not a drop. (Yes, you devotees of the Mediterranean Diet, that includes olive oil, as I’ll explain in Chapter 10.)
• Generally, you cannot eat nuts or avocados.
You can eat a wonderful variety of delicious, nutrient-dense foods:•
*All vegetables except avocado. Leafy green vegetables, root vegetables, veggies that are red, green, purple, orange, and yellowand everything in between
• All legumes—beans, peas, and lentils of all varieties.
• All whole grains and products, such as bread and pasta, that are made from them—as long as they do not contain added fats.
• All fruits.
A Strategy to Arrest and Reverse Coronary Artery Disease: A 5-Year Longitudinal Study of a Single Physician's Practice
From: http://www.heartattackproof.com/
A Strategy to Arrest and Reverse Coronary Artery Disease: A 5-Year Longitudinal Study of a Single Physician's PracticeCaldwell B. Esselstyn, Jr, MD; Stephen G. Ellis, MD;Sharon V. Medendorp, MPH; and Timothy D. Crowe
Methods Results Discussion Conclusions References
Background. Animal experiments and epidemiological studies have suggested that coronary disease could be prevented, arrested, or even reversed by maintaining total serum cholesterol levels below 150 mg/dL (3.88 mmol/ L). In 1985, we began to study how effective one physician could be in helping patients achieve this cholesterol level and what the associated effect of achieving and maintaining this cholesterol level has on coronary disease.
Methods. The study included 22 patients with angiographically documented, severe coronary artery disease that was not immediately life threatening. These patients took cholesterol-lowering drugs and followed a diet that derived no more than 10% of its calories from fat. Disease progression was measured by coronary angiography and quantified with the percent diameter stenosis and minimal lumen diameter methods. Serum cholesterol was measured biweekly for 5 years and monthly thereafter.
Results. Of the 22 participants, 5 dropped out within 2 years, and 17 maintained the diet, 11 of whom completed a mean of 5.5 years of follow-up. All 11 of these participants reduced their cholesterol level from a mean baseline of 246 mg/dL (6.36 mmol/L) to below 150mg/dL (3.88 mmol/L). Lesion analysis by percent stenosis showed that of 25 lesions, 11 regressed and 14 remained stable. Mean arterial stenosis decreased from 53.4% to 46.2% (estimated decrease=7%; 95% confidence interval [CI], 3.3 to 10.7, P<.05). Analysis by minimal lumen diameter of 25 lesions fotind that 6 regressed, 14 remained stable, and 5 progressed. Mean lumen diameter increased from 1.3 mm to 1.4 mm (estimated in crease=0.08 mm; 95% CI, --0.06 to 0.22, P=NS). Disease was clinically arrested in all 11 participants, and none had new infarctions. Among the 11 remaining patients after 10 years, six continued the diet and had no further coronary events, whereas the five dropouts who resumed their pre-study diet reported 10 coronary events. Conclusions. A physician can influence patients in the decision to adopt a very low-fat diet that, combined with lipid-lowering drugs, can reduce cholesterol levels to below150 mg/dL and uniformly result in the arrest or reversal of coronary artery disease. Key words. Coronary disease; cholesterol; nutrition; atherosclerosis; preventive medicine. (J Earn Pract 1995; 41:560-568)
By the mid-1980s, experimental studies on animals and epidemiological studies had indicated that total serum cholesterol levels below 150 mg/dL (3.88 mmol/L)were associated with the absence of atherosclerotic heart disease and with possible arrest and even reversal of the effects of heart disease."2 It was also evident that very low-fat diets, with and without drugs, could reduce progression and achieve partial regression of coronary artery disease in humans.3-'5
These studies caused one of the authors (C.B.E) to rethink the treatment of heart disease, as well as his own lifestyle. Aware that medical, angiographic, and surgical interventions were treating only the symptoms of heart disease and believing that a fundamentally different approach to treatment was necessary, he identified through referrals a number of heart patients willing to adopt a program of major dietary change and to be followed for several years so that the effects of the regimen could be documented. This article describes the medical changes that occurred in these participants after maintaining a very low-fat diet over several years. It presents the results of an exploratory study on what a single physician can accomplish with his or her patients, without additional funding, expensive interventions, or a large medical infrastructure.
A Strategy to Arrest and Reverse Coronary Artery Disease: A 5-Year Longitudinal Study of a Single Physician's PracticeCaldwell B. Esselstyn, Jr, MD; Stephen G. Ellis, MD;Sharon V. Medendorp, MPH; and Timothy D. Crowe
Methods Results Discussion Conclusions References
Background. Animal experiments and epidemiological studies have suggested that coronary disease could be prevented, arrested, or even reversed by maintaining total serum cholesterol levels below 150 mg/dL (3.88 mmol/ L). In 1985, we began to study how effective one physician could be in helping patients achieve this cholesterol level and what the associated effect of achieving and maintaining this cholesterol level has on coronary disease.
Methods. The study included 22 patients with angiographically documented, severe coronary artery disease that was not immediately life threatening. These patients took cholesterol-lowering drugs and followed a diet that derived no more than 10% of its calories from fat. Disease progression was measured by coronary angiography and quantified with the percent diameter stenosis and minimal lumen diameter methods. Serum cholesterol was measured biweekly for 5 years and monthly thereafter.
Results. Of the 22 participants, 5 dropped out within 2 years, and 17 maintained the diet, 11 of whom completed a mean of 5.5 years of follow-up. All 11 of these participants reduced their cholesterol level from a mean baseline of 246 mg/dL (6.36 mmol/L) to below 150mg/dL (3.88 mmol/L). Lesion analysis by percent stenosis showed that of 25 lesions, 11 regressed and 14 remained stable. Mean arterial stenosis decreased from 53.4% to 46.2% (estimated decrease=7%; 95% confidence interval [CI], 3.3 to 10.7, P<.05). Analysis by minimal lumen diameter of 25 lesions fotind that 6 regressed, 14 remained stable, and 5 progressed. Mean lumen diameter increased from 1.3 mm to 1.4 mm (estimated in crease=0.08 mm; 95% CI, --0.06 to 0.22, P=NS). Disease was clinically arrested in all 11 participants, and none had new infarctions. Among the 11 remaining patients after 10 years, six continued the diet and had no further coronary events, whereas the five dropouts who resumed their pre-study diet reported 10 coronary events. Conclusions. A physician can influence patients in the decision to adopt a very low-fat diet that, combined with lipid-lowering drugs, can reduce cholesterol levels to below150 mg/dL and uniformly result in the arrest or reversal of coronary artery disease. Key words. Coronary disease; cholesterol; nutrition; atherosclerosis; preventive medicine. (J Earn Pract 1995; 41:560-568)
By the mid-1980s, experimental studies on animals and epidemiological studies had indicated that total serum cholesterol levels below 150 mg/dL (3.88 mmol/L)were associated with the absence of atherosclerotic heart disease and with possible arrest and even reversal of the effects of heart disease."2 It was also evident that very low-fat diets, with and without drugs, could reduce progression and achieve partial regression of coronary artery disease in humans.3-'5
These studies caused one of the authors (C.B.E) to rethink the treatment of heart disease, as well as his own lifestyle. Aware that medical, angiographic, and surgical interventions were treating only the symptoms of heart disease and believing that a fundamentally different approach to treatment was necessary, he identified through referrals a number of heart patients willing to adopt a program of major dietary change and to be followed for several years so that the effects of the regimen could be documented. This article describes the medical changes that occurred in these participants after maintaining a very low-fat diet over several years. It presents the results of an exploratory study on what a single physician can accomplish with his or her patients, without additional funding, expensive interventions, or a large medical infrastructure.
Monday, January 12, 2009
Hormone therapy linked to brain shrinkage in older women
http://www.cnn.com/
By Anne Harding
Not too long ago, millions of postmenopausal women were taking estrogen as part of hormone therapy to protect their hearts, prevent cancer, and keep their brains sharp.
Hormone therapy may place older women at a higher risk of heart attack, brain shrinkage and breast cancer.
But two new studies in the journal Neurology show that not only does hormone replacement therapy increase the risk of heart attack, stroke, blood clots, and breast cancer in women over the age of 65, but it also shrinks their brains.
"This is extra-double-triple reason not to go on estrogen after 65," said Dr. Constantine Lyketsos of the Johns Hopkins Bayview Medical Center in East Baltimore, Maryland. Lyketsos, an expert on dementia treatment, was not involved in the research.
Experts say the findings should not be cause for alarm among younger women who are taking estrogen according to the current guidelines.
The U.S. Food and Drug Administration recommends that women who take hormones to treat hot flashes and other menopausal symptoms start doing so as early as possible, at the lowest effective dose, for the shortest time possible. Women who haven't had a hysterectomy need to take a combination of estrogen and progestin, because estrogen alone increases the risk of cancer of the lining of the uterus; women who've had their uterus removed can take estrogen alone.
There is good evidence that for younger women, estrogen can actually help defog the brain, improve mental function, and possibly even protect against Alzheimer's disease decades later, said Dr. Pauline Maki, who runs a research program on steroid hormones' effect on cognitive function at the University of Illinois at Chicago. She was not involved with the new studies.
One of the most plausible explanations for this paradox is the "healthy cell bias of estrogen." In other words, estrogen is good for healthy cells, and bad for unhealthy cells, she explained. In her own research, Maki has shown that women who experience an unusually high number of hot flashes during menopause have worse verbal memory.
"What I think happens is that women's brains during hot flashes, while they're not sleeping as well -- the brain material is still fine," Maki said. "When you introduce estrogen to these women, you're introducing it into a healthy cell, and the results, cognitively, are generally beneficial."
Health.com: How to cope with hot flashes without using estrogen
Older women's brain cells are likely to be in worse shape than younger women's, especially if their mental faculties are already fading.
"The scenario that seems to arise is one where [hormone therapy] at the dose of this trial is harmful to the frailest brains, but perhaps not to the strongest ones," said Giovanni Frisoni, of the National Center for Research and Care of Alzheimer's Disease in Brescia, Italy. Frisoni has studied estrogen's effects on brain volumes, but was not involved in the new research.
The two news studies are offshoots of the Women's Health Initiative Memory Study (WHIMS), which found an increased risk of dementia in women on hormone therapy. WHIMS is a parallel study to the Women's Health Initiative, the landmark clinical trial, which in 2002 found that hormone therapy was hurting some women more than it helped them.
The WHIMS researchers had suspected that the women on hormone therapy would have blood vessel disease in the brain, which can destroy brain tissue by restricting blood flow to cells, leading to mental impairment and resulting in vascular dementia. To investigate, two WHIMS teams examined brain MRI scans from 1,403 women participating in the study.
"Much to our surprise, something else was going on," said Susan Resnick of the National Institute on Aging's Intramural Research Program, who led one of the studies. Two memory-related brain regions, the frontal lobes and the hippocampus, were slightly but definitely smaller among women taking hormones. Health.com: How to age-proof your memory
"These negative effects were really most evident in women who seemed to already be having some low cognitive function and possibly some memory problems," Resnick said.
Among the women with the smallest amount of vascular damage in their brains, she added, hormone therapy had no effect on the volume of these brain regions. Health.com: The best memory boosters for women
The degree of atrophy suggests a small but real increase in the dementia risk, said Resnick. Starting hormone therapy likely accelerated the disease process in already-vulnerable women, she said.
Health Library
MayoClinic.com: Hot flashes-- Minimize discomfort during menopause
MayoClinic.com: Menopause
MayoClinic.com: Hormone therapy-- Is it right for you?
In the second study, Laura Coker of Wake Forest University Health Sciences, in Winston-Salem, North Carolina, and colleagues, found that women taking estrogen and progestin had slightly larger areas of vascular damage in their brains than those on placebo. The difference wasn't significant, making it clear that vascular disease wasn't behind the women's increased dementia risk.
"When this type of hormone therapy is initiated, you get volume loss in these key brain areas, and where there's loss of volume, there's loss of function," said Maki. Health.com: Foods that boost your brain power
Investigators are looking into other formulations of estrogen and progestin, as well as very low doses of the hormones, to see if they might be safer than the formulation and relatively higher dose taken by participants in the Women's Health Study.
In the 1990s, more than half of menopausal women said they had taken hormones at some point, and one-third took them for at least five years. About 38 percent of women ages 50 to 70 were taking hormones, according to surveys at the time.
Prescriptions for the two most commonly prescribed hormone products, Premarin and Prempro, dropped from 61 million prescriptions in 2001 to 21 million in 2004, according to the National Cancer Institute.
By Anne Harding
Not too long ago, millions of postmenopausal women were taking estrogen as part of hormone therapy to protect their hearts, prevent cancer, and keep their brains sharp.
Hormone therapy may place older women at a higher risk of heart attack, brain shrinkage and breast cancer.
But two new studies in the journal Neurology show that not only does hormone replacement therapy increase the risk of heart attack, stroke, blood clots, and breast cancer in women over the age of 65, but it also shrinks their brains.
"This is extra-double-triple reason not to go on estrogen after 65," said Dr. Constantine Lyketsos of the Johns Hopkins Bayview Medical Center in East Baltimore, Maryland. Lyketsos, an expert on dementia treatment, was not involved in the research.
Experts say the findings should not be cause for alarm among younger women who are taking estrogen according to the current guidelines.
The U.S. Food and Drug Administration recommends that women who take hormones to treat hot flashes and other menopausal symptoms start doing so as early as possible, at the lowest effective dose, for the shortest time possible. Women who haven't had a hysterectomy need to take a combination of estrogen and progestin, because estrogen alone increases the risk of cancer of the lining of the uterus; women who've had their uterus removed can take estrogen alone.
There is good evidence that for younger women, estrogen can actually help defog the brain, improve mental function, and possibly even protect against Alzheimer's disease decades later, said Dr. Pauline Maki, who runs a research program on steroid hormones' effect on cognitive function at the University of Illinois at Chicago. She was not involved with the new studies.
One of the most plausible explanations for this paradox is the "healthy cell bias of estrogen." In other words, estrogen is good for healthy cells, and bad for unhealthy cells, she explained. In her own research, Maki has shown that women who experience an unusually high number of hot flashes during menopause have worse verbal memory.
"What I think happens is that women's brains during hot flashes, while they're not sleeping as well -- the brain material is still fine," Maki said. "When you introduce estrogen to these women, you're introducing it into a healthy cell, and the results, cognitively, are generally beneficial."
Health.com: How to cope with hot flashes without using estrogen
Older women's brain cells are likely to be in worse shape than younger women's, especially if their mental faculties are already fading.
"The scenario that seems to arise is one where [hormone therapy] at the dose of this trial is harmful to the frailest brains, but perhaps not to the strongest ones," said Giovanni Frisoni, of the National Center for Research and Care of Alzheimer's Disease in Brescia, Italy. Frisoni has studied estrogen's effects on brain volumes, but was not involved in the new research.
The two news studies are offshoots of the Women's Health Initiative Memory Study (WHIMS), which found an increased risk of dementia in women on hormone therapy. WHIMS is a parallel study to the Women's Health Initiative, the landmark clinical trial, which in 2002 found that hormone therapy was hurting some women more than it helped them.
The WHIMS researchers had suspected that the women on hormone therapy would have blood vessel disease in the brain, which can destroy brain tissue by restricting blood flow to cells, leading to mental impairment and resulting in vascular dementia. To investigate, two WHIMS teams examined brain MRI scans from 1,403 women participating in the study.
"Much to our surprise, something else was going on," said Susan Resnick of the National Institute on Aging's Intramural Research Program, who led one of the studies. Two memory-related brain regions, the frontal lobes and the hippocampus, were slightly but definitely smaller among women taking hormones. Health.com: How to age-proof your memory
"These negative effects were really most evident in women who seemed to already be having some low cognitive function and possibly some memory problems," Resnick said.
Among the women with the smallest amount of vascular damage in their brains, she added, hormone therapy had no effect on the volume of these brain regions. Health.com: The best memory boosters for women
The degree of atrophy suggests a small but real increase in the dementia risk, said Resnick. Starting hormone therapy likely accelerated the disease process in already-vulnerable women, she said.
Health Library
MayoClinic.com: Hot flashes-- Minimize discomfort during menopause
MayoClinic.com: Menopause
MayoClinic.com: Hormone therapy-- Is it right for you?
In the second study, Laura Coker of Wake Forest University Health Sciences, in Winston-Salem, North Carolina, and colleagues, found that women taking estrogen and progestin had slightly larger areas of vascular damage in their brains than those on placebo. The difference wasn't significant, making it clear that vascular disease wasn't behind the women's increased dementia risk.
"When this type of hormone therapy is initiated, you get volume loss in these key brain areas, and where there's loss of volume, there's loss of function," said Maki. Health.com: Foods that boost your brain power
Investigators are looking into other formulations of estrogen and progestin, as well as very low doses of the hormones, to see if they might be safer than the formulation and relatively higher dose taken by participants in the Women's Health Study.
In the 1990s, more than half of menopausal women said they had taken hormones at some point, and one-third took them for at least five years. About 38 percent of women ages 50 to 70 were taking hormones, according to surveys at the time.
Prescriptions for the two most commonly prescribed hormone products, Premarin and Prempro, dropped from 61 million prescriptions in 2001 to 21 million in 2004, according to the National Cancer Institute.
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