From: Your Total Health News.
February 19 (HealthDay News) -- A rise in blood sugar levels causes poorer brain function in people with type 2 diabetes, according to a study that included nearly 3,000 people aged 55 and older at 52 sites in Canada and the United States.
The participants, who were part of a larger study on cardiovascular risk in diabetes, underwent cognitive tests designed to measure several aspects of memory function. The researchers found that a 1 percent increase in A1C levels (average blood glucose levels over a period of two to three months) was associated with slightly lower scores on tests of psychomotor speed, global cognitive function, memory and multi-tasking.
However, no link was found between tests scores and daily blood glucose levels, which are measured by a fasting plasma glucose test.
The findings appear in the February issue of Diabetes Care.
"One of the little-known complications of type 2 diabetes is memory decline leading to dementia, particularly Alzheimer's disease," principal investigator Dr. Jeff Williamson, of Wake Forest University Baptist Medical Center, said in a news release from the university.
"This study adds to the growing evidence that poorer blood glucose control is strongly associated with poorer memory function and that these associations can be detected well before a person develops severe memory loss," he said.
Previous research has shown that people with diabetes are 1.5 times more likely than those without diabetes to experience cognitive decline and develop dementia.
Williamson said that "people with type 2 diabetes and their health-care providers need to be careful in situations where there is education and teaching about diabetes care, as patients may need a little more time to absorb and process information."
And he urged people with diabetes to "be open to having a family member periodically making sure they are keeping track of managing their diabetes through monitoring, diet, exercise and medication."
Wake Forest University Baptist Medical Center, news release, Feb. 11, 2009
Friday, February 20, 2009
Glycemic Goals Clarified: HbA1c Of 7% Still Ceiling: Three groups issue position statement.
From: Clinical Endocrinology News
MIRIAM E. TUCKER (Senior Writer)
A target hemoglobin A1c of less than 7% should remain the general goal for nonpregnant adults with diabetes, despite the recent results from three large randomized trials showing that intensive glucose lowering did not reduce the risks of cardiovascular disease in people with longstanding type 2 diabetes.
But glycemic targets that are either more or less stringent than that standard may be prudent for certain individuals with diabetes, according to a joint position statement issued by the American College of Cardiology, American Diabetes Association, and American Heart Association and published online in their respective journals: the Journal of the American College of Cardiology, Diabetes Care, and Circulation.
“The ADA/AHA/ACC position statement is very well thought out and very well articulated. The authors should be commended for their concise analysis of the available data,” Dr. J. Michael Gonzalez-Campoy, medical director and CEO, Minnesota Center for Obesity, Metabolism, and Endocrinology, said in an interview.
The three organizations conducted a careful reexamination of glycemic control guidelines in light of the findings from the Action to Control Cardiovascular Risk in Diabetes (ACCORD), the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and the Veterans Affairs Diabetes Trial (VADT). All showed no significant reduction in cardiovascular outcomes with intensive glucose control, but the ACCORD caused particular concern—and was halted early—because it showed a 22% increase in mortality among subjects randomized to a strategy of very intensive glycemic control with a target HbA1c of less than 6% (N. Engl. J. Med. 2008;358:2545–9).
Still, “The evidence obtained from ACCORD, ADVANCE, and VADT does not suggest the need for major changes in glycemic control targets, but rather additional clarification of the language that has consistently stressed individualization,” Dr. Jay S. Skyler and his associates wrote (Diabetes Care 2009;32:187–92).
Those clarifications include:
▸ To prevent microvascular and neuropathic complications in people with both type 1 and type 2 diabetes, the HbA1c goal for nonpregnant adults in general remains less than 7%. This recommendation is based on robust data from long-term studies including the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS).
The American Association of Clinical Endocrinologists (AACE), which was not part of the group issuing the statement, recommends aiming for an HbA1c level of 6.5% or less.
▸ The general HbA1c goal of less than 7% also “appears reasonable” for prevention of macrovascular disease among those with recent onset of diabetes, based on long-term follow-up of the DCCT and UKPDS cohorts.
▸ For selected individual patients, even lower HbA1c goals than the general goal of less than 7% might be reasonable, provided that this target can be achieved without significant hypoglycemia or other adverse effects of treatment. Such individuals might include those with short duration of diabetes, long life expectancy, and no significant cardiovascular disease. This recommendation was based on subgroup analyses of the DCCT, UKPDS, and the microvascular evidence from the ADVANCE trial.
▸ Conversely, less stringent HbA1c goals may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, or extensive comorbid conditions or those with longstanding diabetes in whom the general goal is difficult to attain despite diabetes self-management and education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents, including insulin.
▸ For primary and secondary cardiovascular risk reduction in patients with diabetes, providers should continue to follow the evidence-based recommendations for blood pressure treatment, lipid-lowering with statins, aspirin prophylaxis, smoking cessation, and healthy lifestyle behaviors delineated in the ADA Standards of Medical Care in Diabetes (Diabetes Care 2008;31[suppl 1]:s12–54) and the AHA/ADA guidelines for primary CVD prevention (Circulation 2007;115?:114–26).
Dr. Gonzalez-Campoy, who serves on the AACE board of directors, agreed with the recommendations. “The ACCORD, ADVANCE, and VADT emphasize the need to individualize care. … The recent publications that show no benefit in cardiovascular outcomes with attempts at normalizing glycemic control were all done on people with [longstanding] type 2 diabetes. Therefore, these findings are not applicable to people with type 1 diabetes, nor do they apply to people with new-onset diabetes mellitus.”
“People with type 2 diabetes who may achieve normal A1c values with lifestyle changes alone, or with weight management, should not increase their A1c values,” Dr. Gonzalez-Campoy added.
Indeed, a substudy of VADT presented at the ADA's annual meeting in June suggested that individuals earlier in their history of type 2 diabetes had the most benefit of improved glycemic control, noted Dr. Daniel Einhorn, head of the Sharp Diabetes Treatment and Research Center, San Diego.
“The key is not to throw out the baby with the bathwater. The VADT and ACCORD suggest that some populations may not benefit from tight glycemic control and there may be risks associated with tight control in these same populations, i.e with cardiovascular disease and/or increased risk of hypoglycemia. This does not detract from the wealth of information that good glycemic control confers benefit on microvascular disease and, given a long enough window, cardiovascular disease,” said Dr. Einhorn, also on the AACE board of directors.
Dr. Einhorn is a consultant to Takeda, Eli Lilly, Amylin Pharmaceuticals, and Merck.
MIRIAM E. TUCKER (Senior Writer)
A target hemoglobin A1c of less than 7% should remain the general goal for nonpregnant adults with diabetes, despite the recent results from three large randomized trials showing that intensive glucose lowering did not reduce the risks of cardiovascular disease in people with longstanding type 2 diabetes.
But glycemic targets that are either more or less stringent than that standard may be prudent for certain individuals with diabetes, according to a joint position statement issued by the American College of Cardiology, American Diabetes Association, and American Heart Association and published online in their respective journals: the Journal of the American College of Cardiology, Diabetes Care, and Circulation.
“The ADA/AHA/ACC position statement is very well thought out and very well articulated. The authors should be commended for their concise analysis of the available data,” Dr. J. Michael Gonzalez-Campoy, medical director and CEO, Minnesota Center for Obesity, Metabolism, and Endocrinology, said in an interview.
The three organizations conducted a careful reexamination of glycemic control guidelines in light of the findings from the Action to Control Cardiovascular Risk in Diabetes (ACCORD), the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and the Veterans Affairs Diabetes Trial (VADT). All showed no significant reduction in cardiovascular outcomes with intensive glucose control, but the ACCORD caused particular concern—and was halted early—because it showed a 22% increase in mortality among subjects randomized to a strategy of very intensive glycemic control with a target HbA1c of less than 6% (N. Engl. J. Med. 2008;358:2545–9).
Still, “The evidence obtained from ACCORD, ADVANCE, and VADT does not suggest the need for major changes in glycemic control targets, but rather additional clarification of the language that has consistently stressed individualization,” Dr. Jay S. Skyler and his associates wrote (Diabetes Care 2009;32:187–92).
Those clarifications include:
▸ To prevent microvascular and neuropathic complications in people with both type 1 and type 2 diabetes, the HbA1c goal for nonpregnant adults in general remains less than 7%. This recommendation is based on robust data from long-term studies including the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS).
The American Association of Clinical Endocrinologists (AACE), which was not part of the group issuing the statement, recommends aiming for an HbA1c level of 6.5% or less.
▸ The general HbA1c goal of less than 7% also “appears reasonable” for prevention of macrovascular disease among those with recent onset of diabetes, based on long-term follow-up of the DCCT and UKPDS cohorts.
▸ For selected individual patients, even lower HbA1c goals than the general goal of less than 7% might be reasonable, provided that this target can be achieved without significant hypoglycemia or other adverse effects of treatment. Such individuals might include those with short duration of diabetes, long life expectancy, and no significant cardiovascular disease. This recommendation was based on subgroup analyses of the DCCT, UKPDS, and the microvascular evidence from the ADVANCE trial.
▸ Conversely, less stringent HbA1c goals may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, or extensive comorbid conditions or those with longstanding diabetes in whom the general goal is difficult to attain despite diabetes self-management and education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents, including insulin.
▸ For primary and secondary cardiovascular risk reduction in patients with diabetes, providers should continue to follow the evidence-based recommendations for blood pressure treatment, lipid-lowering with statins, aspirin prophylaxis, smoking cessation, and healthy lifestyle behaviors delineated in the ADA Standards of Medical Care in Diabetes (Diabetes Care 2008;31[suppl 1]:s12–54) and the AHA/ADA guidelines for primary CVD prevention (Circulation 2007;115?:114–26).
Dr. Gonzalez-Campoy, who serves on the AACE board of directors, agreed with the recommendations. “The ACCORD, ADVANCE, and VADT emphasize the need to individualize care. … The recent publications that show no benefit in cardiovascular outcomes with attempts at normalizing glycemic control were all done on people with [longstanding] type 2 diabetes. Therefore, these findings are not applicable to people with type 1 diabetes, nor do they apply to people with new-onset diabetes mellitus.”
“People with type 2 diabetes who may achieve normal A1c values with lifestyle changes alone, or with weight management, should not increase their A1c values,” Dr. Gonzalez-Campoy added.
Indeed, a substudy of VADT presented at the ADA's annual meeting in June suggested that individuals earlier in their history of type 2 diabetes had the most benefit of improved glycemic control, noted Dr. Daniel Einhorn, head of the Sharp Diabetes Treatment and Research Center, San Diego.
“The key is not to throw out the baby with the bathwater. The VADT and ACCORD suggest that some populations may not benefit from tight glycemic control and there may be risks associated with tight control in these same populations, i.e with cardiovascular disease and/or increased risk of hypoglycemia. This does not detract from the wealth of information that good glycemic control confers benefit on microvascular disease and, given a long enough window, cardiovascular disease,” said Dr. Einhorn, also on the AACE board of directors.
Dr. Einhorn is a consultant to Takeda, Eli Lilly, Amylin Pharmaceuticals, and Merck.
Tuesday, January 27, 2009
Feel Better, Live Longer
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.
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.
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.
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