Follow me on twitter @drportnay for daily thoughts, comments on recent news items and retweets

Tuesday, December 10, 2013

Great article from NY Times on the benefits of snacking on nuts

Snacking Your Way to Better Health

  • by JANE E. BRODY 
  •  Dec. 9, 2013 
  •  original
Personal Health

Jane Brody on health and aging.

Nuts to you! No, that's not an insult. It's a recommendation to add nuts to your diet for the sake of your health and longevity.

Consistent evidence for the health benefits of nuts has been accumulating since the early 1990s. Frequent nut consumption has been linked to a reduced risk of major chronic diseases, including heart and blood vessel disorders and Type 2 diabetes.

The newest and most convincing findings, reported last month in The New England Journal of Medicine, come from the Nurses' Health Study and the Health Professionals Follow-Up Study, which together have followed nearly 119,000 women and men for decades. Both studies repeatedly recorded what the participants ate (among many other characteristics) and analyzed their diets in relation to the causes of death among the 27,429 people who died since the studies began.

The more often nuts were consumed, the less likely participants were to die of cancer, heart disease and respiratory disease, and not because nut eaters succumbed to other diseases. Their death rate from any cause was lower during the years they were followed. (The nuts in question were pistachios, almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, peanuts and walnuts.)

Those who ate nuts seven or more times a week were 20 percent less likely to die from 1980 to 2010; even among those who consumed nuts less often than once a week, the death rate was 11 percent lower than for those who did not eat them.

I know what you're thinking: Aren't nuts fattening? Yes, an ounce of nuts has 160 to 200 calories, nearly 80 percent from fat.

But in study after study, the more often people ate nuts, the leaner they tended to be.

For example, in a Mediterranean study that tracked the effect of nut consumption on weight gain over the course of 28 months, frequent nut consumers gained less weight than those who never ate nuts, and were 43 percent less likely to become overweight or obese.

How is that possible? First, nuts may be taking the place of other high-calorie snacks, like chips, cookies and candy. And nut eaters may be less likely to snack, period; the fat, fiber and protein in nuts suppresses hunger between meals.

Second, the body may treat calories from nuts differently from those in other high-carbohydrate foods. Third, nut eaters may pursue a healthier lifestyle and burn more calories through exercise.

Whatever the reasons, every study has indicated that nuts make an independent contribution to health and longevity, even after taking other factors into account.

And not just tree nuts. The new study found that peanuts were also linked to a reduced death rate and lower risk of chronic disease. Peanuts are legumes that grow underground, but they share constituents with tree nuts that are believed to protect against a wide range of diseases.

Botanically speaking, nuts are fruits, but most of the nuts we consume are the fruits' seeds — able to produce a new plant when raw. Like the yolk of an egg, seeds must contain nutrients that support healthy tissues.

Thus, all nuts are powerhouses of biologically active substances, most of which are known to protect and promote health. Penny M. Kris-Etherton, a professor of nutrition at Penn State who has studied the effects of nuts on heart disease, describes them as "complex plant foods that are not only rich sources of unsaturated fat but also contain several nonfat constituents," including protein, fiber, plant sterols that can lower cholesterol, and micronutrients like copper and magnesium.

Every one of these substances has been shown to ward off one disease or another. The fat content of nuts alone could account for their ability to support heart health. Nuts have less cholesterol-raising saturated fat than olive oil. On average, 62 percent of the fat in nuts is monounsaturated, the kind that supports healthy levels of protective HDL cholesterol and does not raise blood levels of harmful LDL cholesterol.

Nuts contain omega-3 fatty acids that can lower triglycerides and blood pressure, slow the buildup of arterial plaque and prevent abnormal heart rhythms. Walnuts are especially rich sources of alpha-linolenic acid, some of which is converted to heart-protective omega-3 fatty acids.

Most nuts, and especially almonds, are good sources of vitamin E, an antioxidant. Joan Sabaté, a nutritionist at Loma Linda University who has studied the health effects of nuts among Seventh-day Adventists, lists folic acid, selenium, magnesium and several phytochemicals among the compounds in nuts that have antioxidant, anti-inflammatory or anticancer properties.

The nurses' study has linked tree nuts to a reduced risk of pancreatic cancer. ATaiwanese study of about 24,000 people found a 58 percent lower risk of colorectal cancer among women who ate peanuts, although a similar effect was not found among men.

In both the nurses' and health professionals' studies, eating nuts more than five times a week was associated with a 25 percent to 30 percent lower risk of needing gallbladder surgery.

Nuts also contain dietary fiber, about a quarter of which is the type that reduces cholesterol and improves blood sugar and weight control. The nurses' study and a study of about 64,000 women in Shanghai found strong evidence that frequent consumption of tree nuts, peanuts and peanut butter reduced the risk of developing Type 2 diabetes.

Peanuts and especially pistachios are rich in resveratrol, which is being investigated for possible anti-aging effects. Pistachios are also rich in arginine, which gives rise to nitric oxide, a substance that improves blood flow and can helpcounter erectile dysfunction.

Including a serving or two of nuts in your daily diet is not challenging. Dr. Kris-Etherton suggests using peanut butter as the protein source in a sandwich, and replacing a cookie snack with a one-ounce serving of mixed nuts. Nuts can also be added to hot or cold cereals, salads, stir fries and desserts.

Wednesday, December 4, 2013

Why a Brisk Walk Is Better


If you are walking to improve your health, it's time to stop strolling and pick up the pace, Gretchen Reynolds reports in this week's Phys Ed column.

From the New York Times

Monday, December 2, 2013

Emotional Eating

As we approach the last month of the year, it's important to be ready and prepared for the holidays. I'm not talking just shopping and parties.... I mean mentally and physically. 

The holidays can bring out the best and the worst in all of us. Our eating plays a big part in how we handle everything.

"Sometimes, it isn't hunger that causes us to reach for our favorite foods. Moods and emotions can also impact our relationship with food and they can interfere with our ability to stick with a healthy eating plan. Emotional eating can be triggered by stress, depression, loneliness, overwhelming job and family pressures, or by a traumatic life event. Even happiness can set it off. People who are susceptible to emotional eating may regard food as a distraction, look to it for comfort, or over-enjoy it when they have something to celebrate. "- Editor of the South Beach Diet.

If emotional eating is getting in the way of achieving your weight-loss goals, the good news is that you can change this pattern of behavior by putting a healthy plan in place.

- Remove temptations from your kitchen
- Keep a journal
- Distract yourself
- Have healthy snacks at the read
- Relieve stress and improve your mood with exercise

Prevent your emotions from getting in the way of your weight-loss goals especially over the holidays. 

Good Luck!!!!

Friday, November 29, 2013

The Power of a Daily Bout of Exercise


A new study suggests a moderate daily exercise session can blunt the harmful effects of overeating and being inactive, which too many of us will be doing as the holidays approach.

Wednesday, November 27, 2013

Heart Attack Pain Similar for Men and Women

A new study found that too much has been made of gender differences in chest pain, the hallmark symptom of heart disease.


Great quick update from the American Heart Association

Scientific Sessions is the American Heart Association's largest annual gathering of scientists and healthcare professionals devoted to the science of cardiovascular diseases and stroke, and the care of patients suffering from these diseases. Many ground breaking discoveries are presented by the top leaders in their field and we, as promoters of public health education , would like to share a few of these discoveries with you.

Coffee may help perk up your blood vessels.The caffeine in a cup of coffee might help your small blood vessels work better, according to research presented at the American Heart Association's Scientific Sessions 2013. The study takes us one step closer to understanding how coffee might benefit cardiovascular health.

How long should you perform CPR? Researchers found more than half of the men studied had symptoms up to a month before cardiac arrest. The good news is that thirty-eight minutes or longer of CPR can improve the chance of a person surviving cardiac arrest and having normal brain function.

As if they'd never smoked! Certain smokers who quit can reduce their risk of heart disease to the level of never-smokers sooner than previously thought, according to a new study. Smoking is the most preventable cause of death in America. Quitters win!

Wednesday, November 20, 2013

New treatment guidelines for lipid treatment for cardiovascular disease

Here are the four major primary and secondary prevention patient groups which the guidelines advocate who should be treated with statins to reduce the risk of atherosclerotic cardiovascular disease (ASCVD)
  • Individuals with clinical ASCVD
  • Individuals with LDL-cholesterol of levels > 190mg/dL, such as those with familial hypercholesterolemia
  • Individuals with diabetes aged 40-75 years old with LDL-cholesterol levels between 70-189 mg/dL and without evidence of ASCVD
  • Individuals without evidence of ASCVD or DM but who have a LDL-cholesterol levels between 70-189 mg/dL and a 10-year risk of ASCVD > 7.5%
The evidence supporting the first three groups of patients is significant and noncontroversial. 

There is significant controversy regarding the fourth group. Some are writing that this recommendation is too narrow. Others are writing that this recommendation is too broad. Many have issues with the risk calculator which is used to calculate the 10-year risk. The guidelines do advocate using novel strategies for further helping to define risk (hsCRP, calcium score by CT scan, carotid intimal thickness by ultrasound) - which I have been using for a few now. I also believe that in treating younger patients, its vital not to just look at their 10-year risk but their lifetime risk of ASCVD.

Always remember, that these are just recommendations and not law and that it is always imperative to discuss the risk assessment and medical therapy with your physician.

Thursday, November 14, 2013

New guidelines published

This past week, The American Heart Association and the American Cardiology Association Task Force on Guidelines published 4 very important reports. These included new guidelines for lipid treatment, new guidelines for CV risk assessment, new guidelines for lifestyle recommendations to reduce CV risk and new guidelines on obesity management. I will be writing much more in separate blog posting regarding lipid treatment and CV risk assessment.

I wanted to comment here on continued the emphasis placed on adherence to a Mediterranean style diet in the new guidelines. Those of you who know me and/or have read my blog know that I am a very strong believer in the benefits of the Mediterranean diet on heart health.

Apr 30, 2013
More good news about the Mediterranean Diet -- Researchers from Greece have reported in the journal Neurology that adherence to a Mediterranean Diet can significantly improve memory functioning. You will recall that the ...
Feb 25, 2013
A very important study was published this week in the New England Journal of Medicine. In one of the largest trials to date, the Mediterranean-Style Diet (either supplemented with extra-virgin olive oil/EVOO or handfuls of ...
Feb 25, 2013
Mediterranean Style Diet. Want to read more about the landmark trial showing the benefits of the Mediterranean-Style Diet, check out these articles: http://nej.md/VypTpf · http://onforb.es/15JjoEa · http://nyti.ms/ZDLAIj.
Dec 14, 2009
... Mediterranean Diet: Alcohol. http://blog.drgourmet.com/the-mediterranean-diet-alcohol/. Sent from my Verizon Wireless BlackBerry. Posted by Dr Portnay at 12:19 PM · Email ThisBlogThis!Share to TwitterShare to Facebook ...
Aug 02, 2009
I continue to be amazed with twitter and its ability to connect peopel of like interests. Recently, I have met Ray Darken and his http://the-mediterranean-diet.com/ website. I love this site and his frequent tweets (@HealthyDietz).
Feb 18, 2010
In countries bordering the Mediterranean Sea, heart disease is less common than in the United States. Researchers believe that foods common to Greece and southern Italy are a major reason for this difference. The February ...
Jun 01, 2011
Beyond just nutritional health, the Mediterranean Diet promotes a way of living that includes the following components, which could explain the positive health benefits. Intense physical activity that includes work and all its ...
Although there is a huge upside to the Mediterranean diet, it does not specifically address issues of caloric restriction and weight loss. For this, I tell my patients to focus on whole foods and avoid processed starches. "Eat more like a caveman" I often tell my patients. I also advise patients that need weight loss to simply cut in half what they currently eat in bread, sweets, potatoes, pasta, and rice. I remind patients that patients who are more than 30lbs overweight that they are 300x more likely die from cardiac disease.
I hope this helps

Monday, November 11, 2013

Testosterone and CV Disease

A study published in the Journal of American Medical Association last week raises initial red flags for the use of testosterone and the risk of increased cardiovascular events.

In this study, investigators were studying patient with "Low-T Syndrome" or low testosterone levels as measured in the blood. These patients studied were at increased risk for cardiac events with 20% having a prior history of MI, 50% having diabetes, and more than 80% having coronary artery disease.

The investigators found that patients taking testosterone had a 30% higher risk of heart attack, stroke and death compared with the Low-T patients not taking testosterone.

This report does not show a "causal" relationship but this "association" does raise red flags. At the very least, patients currently taking or considering starting testosterone therapy should be discussing this report with their physician.

Hunt is on for the last surviving trans fats

Last week, the FDA announced that it will be moving to ban trans fats from our foods permanently. Consumption of these partially hydrogenated oils have been specifically linked to increasing the risk of cardiovascular disease. "The FDA says cutting trans fats could prevent as many as 20,000 heart attacks a year".

Follow this link for a great article from Marketplace that discusses the announcement

Monday, November 4, 2013

A letter from a patient

Here's a terrific note I just received from a patient. Helping people like this feel better is why became a Cardiologist. 

Doctor Portnay,
I just thought I'd drop you an email.  I just want to let you know that
I am feeling great, and I mean great. Somehow that little tweeking
and you telling me to increase my dosage of lasix seemed to do the
trick. The my tireness, and feeling sluggish went away.
I am in Boston and realized that I am back to being myself. I am
walking everywhere with a spring in my step.
So, I want to thank you for saving my life.  I didn't realize how sick
I was. I just plugged along going to work and my slowing down was
hardly noticeable to me.  I thought it was just some thing that happen
in the aging process. I was going down hill fast.  My decline was like some-thing one of my science teachers mentioned to me a million years ago.
Put a frog in cold water and while the heat is turned on, he will sit in the
water it he boils to death.
I was like that frog, I didn't know how sick I was or that my heart was
failing. My sister Chris, working for Cardiology saw something was
wrong with me, and I should be check you by, you specificially.

With your testing and quick action, the pacemaker was installed,
beautifully by Doctor Pittaro.  I was quickly able to get back to
work. It took a while before I noticed that my health generally was
improving. With your positive attitude, and wise counsel I was feeling
better and better.  I'm not sure but I think about a year later, you suggested getting into the Weight Mate program. I lost 40 pounds, changed my whole attitude about food and feel 20 years younger.
Another lucky break for me occurred when I turned 66 and retired.
I suddenly found myself free from the stress of work. I could now focus
on my health issues.  I feel now my future is looking brighter and brighter.
Thanks again,   see you in the spring for the next appointment.

Tuesday, October 29, 2013

Low Fiber Intake Linked to Increase Diabetes and CV Risk

A recent trial from Brigham and Women's Hospital reports that there is a significant association between low dietary fiber intake and cardiometabolic risks, including metabolic syndrome, cardiovascular inflammation, and obesity.
The Institute of Medicine (IOM) recommends the following adequate intake levels for total fiber: 38 g per day for men aged 19-50 years, 30 g per day for men older than 50 years, 25 g per day for women aged 19-50 years, and 21 g per day for women older than 50 years.
In the above mentioned study, the authors found that on average, individuals only consumed 16.2 g per day, well below the IOM total recommended levels. 
Therefore, to lower your cardiometabolic risk (and your waist line too), consider consuming more dietary fiber.

Saturday, October 26, 2013

Almonds For Skinny Snackers? Yes, They Help Curb Your Appetite : The Salt : NPR

Almonds For Skinny Snackers? Yes, They Help Curb Your Appetite

The protein, unsaturated fat composition and fiber in almonds all very likely play a role in helping to curb appetites.
Americans seem to have a love affair with snacking.
As a society, we eat twice as many snacks as we did a generation ago. Women, on average, nosh on upwards of 400 snack calories per day, according to federal survey data. And men consume almost 600 calories a day in between meals.
So, if nibbling is our new pastime, researchers have a suggestion for one satiating snack that seems to help control our appetites: almonds.
According to the findings of fresh research published in the European Journal of Clinical Nutrition, people who added 1.5 ounces of almonds to their diet each day reported reduced hunger, and they compensated for the extra calories from nuts by eating less at other times of the day.
"This research suggests that almonds may be a good snack option, especially for those concerned about weight," says Richard Mattes, a professor of nutrition science at Purdue University. "Despite adding 250 calories to the diet, there was no change in total energy intake."
And after a month of eating almonds each day, the participants did not gain weight.
If you listen to my story on All Things Considered, you'll hear how Glenn Reed of East Orange, N.J., manages to stay slim. We met up with him at Union Station, in Washington, D.C., during the late afternoon commuting rush.
"There's a lot of junk and sugar here [at the train station]," Reed noted, "so I always look for something with nuts in it."
As he munched on trail mix that included almonds and dried cranberries, he says nuts may be calorie dense and full of fat — which many Americans are wary of — but for him, nuts are the perfect snack.
"I love the crunchiness, and this is a snack that will definitely ... hold you over [until dinner]," Reed told me.
So what is it about nuts that can help curb our appetites? It's most likely a combination of factors, explains Mattes.
"The protein, the unsaturated fat composition, the fiber" all very likely play a role, he says. And almonds are low in carbohydrates, which tend to stimulate our appetites.
One other factor? Chewing. As we've reported, research has shown that if we don't chew our almonds thoroughly, some of the calories move right through us — undigested.
Prior research has already shown that almonds help increase satiety, both in people of normal weight and those prone to being overweight.
The new observation here, according to Mattes, is that almonds are even "better at controlling appetite when consumed as snacks."
His team found that eating almonds in between meals tended to blunt the rise in hunger, compared with when people ate the nuts as part of a meal.
It's not clear whether all nuts have this effect. This study was funded by the almond industry, and researchers didn't evaluate other types of nuts.
Mattes explains that industry-funded studies are becoming more common, especially as government funding becomes harder to obtain. But he emphasizes that the research is carried out completely independently and is peer-reviewed before being published.
"So it does have the checks and balances," Mattes concludes.

Good Heart Healthy Tips from the AHA


Let me know if you agree...

We will never forget

While on the anniversary of Super Storm Sandy we here in Fairfield, CT have bright blue skies and the first frost of the season, we will never forget those who suffered and are still suffering from the ravaging effects of Super Storm Sandy.

Wednesday, October 23, 2013

Flu vaccines are not only safe but they reduce major cardiovascular events

In a recently published report, the Flu vaccine has been shown to be associated with impressive reduction in major cardiovascular events. ]
The study examined 6735 patients (mean age 67 years-old, 36.2% with a cardiac history). The trial showed a significant lowering of risk of the composite endpoint of CardioVascular death, hospitalization for heart attack, unstable angina, stroke, heart failure and need for urgent coronary intervention. The number needed to treat was 58. This means that for every 58 patients that received the flu vaccine, one major cardiovascular event was prevented. This is a powerful effect. 
I would encourage all patients to discuss the Flu vaccine with their physician. For older patients and those with known heart disease, I would strongly recommend that you receive a Flu vaccine

Tis the season... To exercise

While there are some seasons that are perfect for celebrating and caroling, some for swimming and barbecuing and some for skiing and making snowmen, now (especially here in the NorthEast) it's the perfect time to get outside and exercise. I been hitting the trails for runs in the woods and enjoying soaking up the foliage on walks/hikes with my family. If you've been wanting to get outside and start exercising - now's the time.

Monday, October 14, 2013

A picture is worth a thousand words

One of the most common complaints patients come into my office with is palpitations or irregular heart beats.

There are many different reasons why patients feel palpitations. Some are totally benign (not serious) and others are dangerous and need to be actively worked-up and treated. 

The first step in diagnosing a palpitation is trying to determine exactly what the heart is doing while a patients is feeling the palpitations. We have many different types of monitors to do this with - depending on the frequency and duration of the patient's symptoms.

Now I have a new weapon and its as simple as an app on an iPhone The iPhone carries a powerful device to help monitor your heartbeat – the camera. By detecting changes in color while illuminating your finger with the built-in flash, the camera can detect the pulse in your arteries at the tip of your finger. 

Cardiograph is one app that does this. As you can see from the photo below, the first few pulses seem a little inaccurate but after that I had a fairly steady pulse at a rate 62bpm.

Although it is not entirely accurate and the app carries warnings on it that the app should not be used for medical purposes, I think for some patients it may be a wonderful way to cheaply and easily start work-up of their symptoms

Friday, October 11, 2013

Caffeine and Atrial Fibrillation


As I lover of coffee, I read a recent report of the lack of connection between atrial fibrillation and caffeine with much relief. Atrial fibrillation is the most prevalent sustained malignant heart rhythm in adults and a leading cause of stroke. 

2 recent studies were published evaluating over 115,000 patients. In the end it was found that caffeine exposure is not associated with increased risk of atrial fibrillation. In fact, low-dose caffeine may even have a protective effect.

I would discuss this finding with your physician but for now, I will continue to drink my beloved dark roast with more reassurance that it is not increasing my risk of atrial fibrillation.

Tuesday, October 8, 2013

Could your sleep be hurting your heart?

For many, snoring is not just an annoying habit that drives your loved ones crazy, it is a symptom of sleep apnea. Other signs of sleep apnea include sleepiness during the day and headaches in the morning.

Sleep apnea is a serious breathing issue.

This condition has be shown to seriously impact the heart. Studies have shown that sleep apnea is linked to hypertension, abnormal heart rhtyhms, heart attacks, heart failure and death. 

Continuous positive airway pressure machine (CPAP) is an effective treatment. CPAP can greatly reduced the frequency and severity of apneic episodes. Two recent studies have shown that using a CPAP can reduce the development of high blood pressure and actually reduce the risk of developing a heart attack. Patients who use CPAP also feel much better during the day with much more energy and less headaches. 

If you or your loved one is a chronic snorer, I suggest you talk to your physician

Thursday, October 3, 2013

Depression and Heart Failure - Another Reason to Exercise

It has long been known that depression occurs frequently in patients suffering from heart failure (HF). Recent trial data has shown that ~ 40% of patients with HF can be classified as having symptoms consistent with depression or severe depression. Patients with HF and depression symptoms more frequently have worse scores on quality of life symptoms (fatigue, lack of energy, listlessness ...).

Do drugs for depression work? A recent trial showed that when sertraline (a classic SSRI anti-depression medication) or placebo was administered to patients, there was difference in symptoms or outcomes.

What does work? A recent trial of HF patients showed that patients who were depressed had less exercise tolerance than the patients who were not depressed. However, when placed on an exercise program, patients depression status improved. Not only that, the more patients exercised, the better they felt.

If you have HF and depression symptoms, please discuss this with you physician. Also try and use consistent exercise - the evidence tells us that it will not only make you feel better but also lead to better outcomes.

Tuesday, October 1, 2013

Positive Attitude Boosts Exercise, Longevity Among Heart Disease Patients, Study Suggests

Here's an excellent article on the benefits of trying to keep a positive attitude. While life can be very stressful, those who keep a positive attitude not only are happy but exercise more and are healthier. 

Therefore, try and smile more ;-)

Positive Attitude Boosts Exercise, Longevity Among Heart Disease Patients, Study Suggests

Sep 11, 2013
Attitude is everything, at least for people with heart disease, a new study suggests.
The research, published in the journal Circulation: Cardiovascular Quality and Outcomes, shows that having a positive attitude is tied to a longer life and greater likelihood of exercising among coronary artery disease patients.
"We should focus not only on increasing positive attitude in cardiac rehabilitation, but also make sure that patients perform exercise on a regular basis, as exercise is associated with both increased levels of optimism and better health," study researcher Susanne S. Pedersen, Ph.D., professor of cardiac psychology at Tilburg University in the Netherlands, said in a statement. Pederson is also an adjunct professor of cardiac psychology at the University of Southern Denmark and Odense University Hospital in Denmark.
The study included 600 people with coronary artery disease who were being treated at a hospital in Denmark. Researchers followed up with them over five years to find an association between positive mood and likelihood of exercising, as well as positive mood and risk of dying over that five-year period.
Specifically, people with positive attitudes who exercised had a 42 percent decreased chance of dying over the study period. Meanwhile, 16.5 percent of those with more negative attitudes died over the study period.
Past studies have also shown a link between having a positive attitude and good health. A study earlier this year in the American Journal of Cardiology shows that having a cheerful disposition could help to lower your risk of experiencing a heart attack. And last year, a study from Duke University Medical Center researchers found that positive thinking about the future was linked with a lower risk of dying from heart disease, the Chicago Tribune reported.
For more health benefits of optimism, click through the slideshow:

Sent from my iPhone

Wednesday, August 7, 2013

Making the Case for Eating Fruit - NYTimes.com

I believe very strongly that eating whole fruits and vegetables is an essential part of a "heart healthy" diet. This is a good article that I thought you would enjoy. 

Making the Case for Eating Fruit

Tony Cenicola/The New York Times

Experts agree that we are eating too much sugar, which is contributing to obesity and other health problems. But in the rush to avoid sugar, many low-carb dieters and others are avoiding fruits. But fresh fruit should not become a casualty in the sugar wars, many nutrition experts say.

Dr. David Ludwig, the director of the New Balance Foundation Obesity Prevention Center at Boston Children's Hospital, said that sugar consumed in fruit is not linked to any adverse health effects, no matter how much you eat. In a recent perspective piece in The Journal of the American Medical Association, he cited observational studies that showed that increased fruit consumption is tied to lower body weight and a lower risk of obesity-associated diseases.

Whole fruits, he explained, contain a bounty of antioxidants and healthful nutrients, and their cellular scaffolding, made of fiber, makes us feel full and provides other metabolic benefits. When you bite into an apple, for example, the fruit's fiber helps slow your absorption of fructose, the main sugar in most fruits. But fiber is not the full story.

"You can't just take an 8-ounce glass of cola and add a serving of Metamucil and create a health food," Dr. Ludwig said. "Even though the fructose-to-fiber ratio might be the same as an apple, the biological effects would be much different."

Fiber provides "its greatest benefit when the cell walls that contain it remain intact," he said. Sugars are effectively sequestered in the fruit's cells, he explained, and it takes time for the digestive tract to break down those cells. The sugars therefore enter the bloodstream slowly, giving the liver more time to metabolize them. Four apples may contain the same amount of sugar as 24 ounces of soda, but the slow rate of absorption minimizes any surge in blood sugar. Repeated surges in blood sugar make the pancreas work harder and can contribute to insulin resistance, thereby increasing the risk for Type 2 diabetes.

"If we take a nutrient-centric approach, just looking at sugar grams on the label, none of this is evident," Dr. Ludwig said. "So it really requires a whole foods view."

Fruit can also help keep us from overeating, Dr. Ludwig said, by making us feel fuller. Unlike processed foods, which are usually digested in the first few feet of our intestines, fiber-rich fruit breaks down more slowly so it travels far longer through the digestive tract, triggering the satiety hormones that tend to cluster further down the small intestines.

Another nutrition expert, Dr. Robert Lustig, a professor of pediatrics at the University of California, San Francisco, who has called sugar "toxic" at high doses and fructose the most "actionable" problem in our diet, is still a fan of fruit. "As far as I'm concerned, fiber is the reason to eat fruit," since it promotes satiety and the slow release of sugar. He adds a third benefit from fiber: it changes our "intestinal flora," or microbiome, by helping different species of healthy bacteria thrive.

Neither doctor favors certain fruits over others. But Dr. David L. Katz, director of the Yale University Prevention Research Center, said that "to maximize the benefit, you actually want a variety" of fruits. He advises "eating the rainbow," since different colors signal different types of antioxidants and nutrients.

All three experts caution against choosing juice over whole fruit. While the best juice has nothing added, nothing subtracted, some important changes take place when you turn fruit into liquid. Chewing the whole fruit slows down consumption, Dr. Katz said, compared to when you "take an 8-ounce juice and just pour it down the hatch," which not only makes it easier to ingest more calories, but releases fructose faster into the bloodstream.

Plus, he said, with juicing, "you reduce some of the metabolic benefit of the fiber by pulverizing it so fine; it changes the physical structure." Commercially produced juices are particularly concerning since they are often filtered, removing fiber altogether. If you opt for juice, tossing whole fruit in a blender rather than squeezing it offers the best chance of retaining most of the fiber, vitamins and minerals.

Dried fruits also hold one of the main disadvantages of juices: volume. Dried fruit essentially concentrates the calories and sugar into smaller packets, making it easier to consume excess calories. But dried fruit is better than juice, Dr. Katz said, because it preserves the fruit's cellular structure, along with the health assets that provides. And since dried fruit travels easily and does not rot, it can make the difference in eating any fruit at all.

Dr. Katz's hierarchy? Fresh fruit, followed closely by dried fruit, with sweetened dried fruit a distant third, and juice in fourth place.

He said we should remember "a law we all learned from Aesop" and judge fructose "by the company it keeps," fiber and all.

Thursday, July 25, 2013

How to Trick Your Brain to Create a New Healthy Habit

I thought this was a great article. 

How to Trick Your Brain to Create a New Healthy Habit

Have you ever started a diet or exercise program but didn't stick with it? If you're like millions of other people, you've set out with the best intentions but failed to keep the momentum going. Here's why relying on motivation and willpower doesn't work (and what works instead).

When you begin any new self-improvement program, your enthusiasm is high and you're motivated by the pleasure of what you want or the pain of what you don't want. But motivation naturally diminishes with time.

When your motivation wanes, you rely more on willpower. But no one has an endless supply of willpower. It's a resource that gets "used up." Every time you will yourself to do something that you don't really want to do, you use up some willpower. It's as if every temptation you pass up depletes your willpower reserve. By evening, you may find you have no willpower left. That's why most people blow their diet in the evening after eating healthy all day. If motivation and willpower aren't working for you, there's another way!

95% of our life is dictated by the subconscious mind, the part of our brain that runs our lives on autopilot. This is why you can do everything from brushing your teeth to driving a car without thinking about it. By consciously deciding to create a new habit, you can harness the power of your unconscious to create a new neural pathway. Once a new habit is established it becomes easy to do—motivation and willpower are no longer required.

Here are seven steps to turn any desired new activity into a habit. Once a habit is established, you'll find yourself doing it effortlessly. These techniques can be used for any habit you want to make or change—diet, exercise, meditation, stress reduction, sleep habits, etc.

Set Small Goals

Setting big goals is exciting but starting with small, boring goals is more likely to lead to success. A small goal, for example, would be to meditate for 10 minutes, or replace one unhealthy snack with raw veggies, or walk 15 minutes per day. Taking small actions tricks your brain. Your subconscious likes to be in control—it doesn't like change. A big change often sets up subconscious resistance, but you can sneak a small change by it.

Use Triggers

A trigger is something that leads you to automatically doing something else. Many smokers, for example, are often triggered to smoke after a meal. Use triggers to your advantage. If you commit to always meditating after breakfast, then after a few weeks you'll automatically think about meditating after your morning meal. Visual triggers work well, too. Laying your workout clothes on the bed in the morning will encourage you to work out when you get home from work.

Do It Early

Exercise or meditate in the morning when your willpower is high, and you'll reap the rewards all day. Make a healthy dinner ahead of time (I love my crockpot!) so you don't come home starving, with nothing to eat.

Be Prepared

Make sure you have everything you need to ensure your success. If you want to start a walking program, get comfortable walking shoes and a pedometer. (People who wear a pedometer walk 27% more than those who don't.)

Make it Convenient

The more difficult and time consuming it is to take an action, the less likely you will do it. This is why so many people who buy gym memberships drop out—it's just not that convenient. Get everything you need ready ahead of schedule so that when it is time to take action, you can, as Nike says, "Just Do It."

Make it Fun

If you don't enjoy doing something, you aren't going to stick with it. Find ways to make your lifestyle change as enjoyable as possible. Exercise with a friend, learn to cook healthy foods that are delicious, or find a meditation program that really resonates with you.

Don't Break the Chain

When Jerry Seinfeld was an unknown, he created the habit of writing new material daily using a wall calendar and a red marker. Every day that he managed to write, he would put a big red "X" on the calendar. He didn't want to see any blank days that "broke the chain." Use this technique for one month and you'll find your new habit will largely be formed.

By using these steps to create a habit, you're tricking your brain into creating a new neural pathway. Once the habit is formed, you can use it to serve as a gateway to bigger changes that can truly change your life. A journey of a thousand miles really does begin with a single step.

How to Trick Your Brain to Create a New Healthy Habit | Pick the Brain

Deane Alban is co-founder of BeBrainFit.com and author of Brain Gold: The Anti-Aging Guide for Your Brain. She has taught and written on a wide variety of natural health topics for over 20 years. Her passion is teaching others how to rejuvenate their brains and overcome the common, but avoidable, problem of midlife mental decline.

Want to see your work on Lifehacker? Email Tessa.

Sent from my iPhone

Tuesday, July 23, 2013

Statins and their risk/benefit

  • A recent large Meta-analysis (a study which combined the results of 135 randomized trials) has shown that statins did not significantly increase risk for myalgia (muscle pain), myopathy (muscle weakness), rhabdomyolysis (muscle breakdown) or cancer as compared with control treatment. There was a slight increase in the risk of diabetes. 

    I remain a strong believer in the benefit of statin therapy to reduce heart attack, strokes and death in patients with known heart disease and in those at intermediate-to-high risk for heart disease. See my prior blog posting explaining my rationale. I have also previously written about ways I help my patients assess their risk of heart disease. 

    Below is an excellent editorial based on the recent trial I cited above which I wanted to share with you:

    "At a time when the major trials continue to support substantial benefit from statin use, especially in patients with known atherosclerotic vascular disease, this study provides important information that the risks of long-term therapy with statins is relatively low.

    But, like all medications, there are benefits and there are risks. We are not at a point at which statins should be placed in the water. We need to be careful that when we recommend statin therapy for primary prevention of CVD we do so with the knowledge that the patients for whom the therapy is recommended should be at increased risk and have their risk identified as a guide to therapy. In the future we will see increasing emphasis placed on the risk-benefit of statin therapy for patients in primary prevention who have not yet experienced an event. There is no doubt that with secondary prevention the benefits of statin therapy far outweigh the risks. From this very interesting study of almost a quarter million patients, we can see that those risks are quite small.

    Recently, the FDA warned that simvastatin at high doses should not be used in most settings. Across the board, we are learning that the problems with statin side effects tend to occur with higher doses. It is important to be careful that we still have a good way of assessing risk and identifying those who will truly benefit from long-term therapy with statins.

    • Sidney C. Smith Jr., MD, FACC, FAHA, FESC
    • Professor of Medicine, University of North Carolina, Chapel Hill
      Past President, AHA
      Previous Chair of the ACC/AHA guidelines committee"

Wednesday, July 3, 2013

Happy 4th of July

Happy Independence Day

No work - what a great day to get out and exercise!!! Go for a walk. Go for a run. Go swimming. Go for a hike. 

Along with all the hot dogs and hamburgers, remember to fill up on salads and fruits. 

Stay away from regular sodas

Try not to drink too much alcohol

Have fun but be healthy

Wednesday, June 19, 2013

4 simple lifestyle changes that can save your life

There are risk factors that people can't control, such as their family history (genetics) and age. However, there are lifestyle changes that people can make that will significantly reduce their risk of developing heart disease.

In a new study recently published, researchers have shown that getting regular exercise, eating a healthy diet, maintaining a normal weight and especially not smoking, protects patients from coronary heart disease and the early build-up of coronary calcium (hardening of the arteries). The presence of coronary calcium has been shown to increase your risk of heart attacks, stroke and death. 

Therefore, although we cannot change who are parents were or make ourselves any younger, we can reduce our risk of developing heart disease by changing how we live, what we do and what we eat. 

Doc - What's that on you wrist?

For the past few months, patients have notice and asked me about the device I wear on my wrist.

I have been wearing the Nike FuelBand

This device which I wear on my wrist inspires me to get active by recording all of my acitivity and converting it into a new fitness currency - NikeFuel.  The more active I am, the more NikeFuel I am rewarded with per day. 

What is Nike fuel "Unlike calorie counts, which vary based on someone's gender and body type, NikeFuel is a normalized score that awards all participants equal scoring for the same activity regardless of their physical makeup."

Nike FuelBand users can decide at the beginning of the day what level of NikeFuel I want to reach that day. The Fuelband then displays how close I am  to achieving my goal via a series of 20 LEDs that gradually go from red to green as you approach your target. Specifically, the Nike FuelBand uses accelerometry to record data about your exercise, which it can then relay to you as time, steps, NikeFuel or calories.

I can track my progress on the fly via the LED read out on the band or sync it to my iPhone (wirelessly) or computer and see more detailed information 

I find the device to be a true lifestyle-changer rather than a tradition training watch. 

There are other new fitness tracking devices on the market, each with there own advantages and disadvantages. 

- UP is a wristband and app that tracks how you sleep, move and eat—then helps you use that information to feel your best.
- However, it does not have a visual screen and must be physically plugged into the iPhone

During the day, it tracks steps, distance, and calories burned. At night, it tracks your sleep cycle and wakes you silently in the morning. Just check out the lights to see how you stack up against your personal goal. It’s the motivation you need to get out and be more active.
- However, it does not have a visual clock (which I use frequently)

While these devices are not for everyone, I do find that the device really helps me to stay active. 

If you are wearing one now or get one in the future, let me know what you think.

Friday, June 7, 2013

Fitness tools that tap the power of your friends - CNN.com


I love using tech to help me stay motivated. Of the 7 tools mentioned in this article, I use RunKeeper and I wear a Nike Fuelband. I'm thinking about trying out Zombies, Run!

If you use technology to help keep you motivated - let us know which ones and how it is working for you.

Think your job is going to kill you, heart healthy living may be able to save you

Studies have shown that high stress jobs are bad for the heart. My patients routinely report to me that the stress of work is effecting not just their emotional but physical well being. 
New evidence now suggests that heart healthy living and avoiding known lifestyle risk factors: smoking, obesity, physical inactivity, and heavy drinking, can reduce the chance of symptomatic heart disease. 
Of the 102,128 healthy participants in the studies, 15,986 reported job strain. That subset was then sorted into these groups: healthy (no lifestyle risk factors), moderately unhealthy (one risk factor), and unhealthy (two to four risk factors).
The primary endpoint was first myocardial infarction or death from cardiovascular disease.
Adults who reported job strain and lived an unhealthy lifestyle were more than twice as likely to develop coronary artery disease in 10 years (HR 2.55, 95% CI 2.18 to 2.98) for a population attributable risk of 26.4%.
Take home message: While we may not be able to decrease our job related stress, heart healthy living can dramatically reduce the chance that our job will kill us.