Health for life

People who are “apple-shaped” — with fat more concentrated around the abdomen — have long been considered more at risk for conditions such as heart disease and diabetes than those who are “pear-shaped” and carry weight more in the buttocks, hips and thighs.

But new research conducted at UC Davis Health System published in The Journal of Clinical Endocrinology and Metabolism provides further evidence that the protective benefits of having a pear-body shape may be more myth than reality. The journal article posted online January 10 and will appear in the March 2013 print edition.

The UC Davis study found that fat stored in the buttock area — also known as gluteal adipose tissue — secretes abnormal levels of chemerin and omentin-1, proteins that can lead to inflammation and a prediabetic condition know as insulin resistance in individuals with early metabolic syndrome.

Metabolic syndrome ers to a group of risk factors that occur together, doubling the risk for heart disease and increasing the risk for diabetes at least five-fold. Risk factors include having a large waistline, low levels of high-density lipoproteins (HDL), or “good” cholesterol, high blood pressure as well as high fasting blood sugar ( insulin resistance) and high triglyceride levels. According to the Centers for Disease Control and Prevention, metabolic syndrome affects 35 percent of American adults over age 20.

“Fat in the abdomen has long been considered the most detrimental to health, and gluteal fat was thought to protect against diabetes, heart disease and metabolic syndrome,” said Ishwarlal Jialal, lead author of the study and a professor of pathology and laboratory medicine and of internal medicine at UC Davis. ”But our research helps to dispel the myth that gluteal fat is ‘innocent.’ It also suggests that abnormal protein levels may be an early indicator to identify those at risk for developing metabolic syndrome.”

The UC Davis team found that in individuals with early metabolic syndrome, gluteal fat secreted elevated levels of chemerin and low levels of omentin-1 — proteins that correlate with other factors known to increase the risk for heart disease and diabetes. High chemerin levels, for example, correlated with high blood pressure, elevated levels of C-reactive protein (a sign of inflammation) and triglycerides, insulin resistance, and low levels of HDL cholesterol. Low omentin-1 levels correlated with high levels of triglycerides and blood glucose levels and low levels of HDL cholesterol.

“High chemerin levels correlated with four of the five characteristics of metabolic syndrome and may be a promising biomarker for metabolic syndrome,” said Jialal. “As it’s also an indicator of inflammation and insulin resistance, it could also emerge as part of a biomarker panel to define high-risk obesity states. The good news is that with weight loss, you can reduce chemerin levels along with the risk for metabolic syndrome.”

To conduct the study, Jialal and colleagues recruited 45 patients with early metabolic syndrome — defined as having at least three risk factors for metabolic syndrome including central obesity, hypertension, mild increases in glucose levels not yet in the diabetic range (<126 mg/dl), hyperlipidemia without cardiovascular disease or diabetes. A control group of 30 subjects had less than two risk factors for metabolic syndrome, with normal glucose and triglyceride levels. Both groups were matched for gender and age.

Complete blood counts, lipid profiles and blood glucose, blood pressure and C-reactive protein levels were measured in all participants. Levels of four proteins secreted by adipose tissue — chemerin, resistin, visfatin and omentin-1 — were also measured in plasma and in subcutaneous fat samples from gluteal tissue.

The researchers found that chemerin levels were increased and omentin-1 levels were decreased in both plasma and gluteal fat of subjects with metabolic syndrome compared to those in the control group. The abnormal levels of these two proteins were also independent of age, body mass index and waist circumference.

“Future large epidemiological studies should focus on evaluating the role of chemerin as a biomarker for the development of diabetes and cardiovascular disease in metabolic syndrome,” Jialal said.

AstraZeneca and Ardea Biosciences today presented results from a large study of allopurinol, a treatment commonly used to lower uric acid in patients with gout. The LASSO (Long-term Allopurinol Safety Study evaluating Outcomes in gout patients) study was a multinational, 6-month, open, prospective observational study involving 1,735 patients with gout and was designed to evaluate the safety and efficacy of medically appropriate doses of allopurinol. Results of the LASSO study showed no new safety signals with allopurinol doses of approximately 300mg/day. The study also revealed that at the time of last dose fewer than half (43%) of patients taking allopurinol achieved the target serum uric acid (sUA) level of <6.0 mg/dL, the level recommended by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). Results of the LASSO study were presented today at the ACR Annual Meeting in San Diego, CA.

Allopurinol, the most commonly used treatment to lower blood uric acid levels in gout, is a generic treatment that has been available for more than 50 years. It is a xanthine oxidase inhibitor, a class of drugs intended to reduce the bodys production of uric acid. Allopurinol is recommended at doses between 100mg and 900mg per day, depending upon disease severity. The LASSO study encouraged investigators to increase, or titrate, the dose of allopurinol over the six months of the study to a medically appropriate dose. There was a high rate of adherence to therapy (97% across doses) and the most commonly used dose was 300mg. Approximately 45% of patients finished on the same dose as their baseline dose. Results show that even among patients titrated to final doses above the most commonly used dose of 300mg/day, approximately 46% did not reach target sUA levels of <6.0 mg/dL.

"Gout is a painful form of arthritis that is often misunderstood and inadequately treated. The LASSO study demonstrates that many patients with gout fail to reach the recommended treatment goal," said study co-author Nicola Dalbeth, MD of the University of Auckland. "Failing to reach the recommended sUA target leaves patients with gout at risk for further disease progression and long-term consequences of gout."

The results of this large, multinational, prospective observational study of gout are consistent with published literature confirming many patients do not reach sUA targets with allopurinol therapy as currently used.

Specific findings from LASSO include:

- The study revealed no new safety signals with allopurinol (approximately 300mg/day).
- There were no cases of allopurinol hypersensitivity syndrome in this study.
At the time of last dose 43% of all patients in the study achieved target sUA levels of <6.0 mg/dL.
- Of patients in the study at final doses above 300mg/day, approximately 54% achieved target sUA levels of <6.0 mg/dL.
- Gout is the most common form of inflammatory arthritis with a prevalence of 8 million in the U.S. Gout is commonly misrepresented as a lifestyle disease. While diet can contribute to elevated levels of uric acid, the majority of uric acid is produced by the bodys naturally occurring processes, and gout is most often caused by the inefficient excretion of uric acid by the kidneys.
- In patients with gout, abnormally high levels of uric acid in the blood known as hyperuricemia lead to deposition of needle-like crystals in joints and soft tissues throughout the body, causing inflammation. Hyperuricemia results when the kidneys do not efficiently remove enough uric acid, or when the body produces too much. A persons genetics play a significant role in their risk of developing gout. The most common symptom of gout is extremely painful arthritis. Over time, the deposits of uric acid crystals may lead to joint damage, visible nodules called tophi, and impaired quality of life. Additionally, gout has been associated with serious health problems including cardiovascular disease, diabetes and kidney damage.

I hate to say I told you so.  But I did.  Like a million times.  Yet, the fear of cholesterol continues.  What is it?  Is it the Lipitor ads?  Is it your cholesterol-phobic doctor, determined to get your cholesterol under 200 mg/dl at all cost?  Whatever it is, its about time we stopped worrying so damn much about high cholesterol.  This new study, entitled "Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid?  Ten years prospective data from the Norwegian HUNT 2 study.", shows us why.  Did anybody hear anything about this one in the media??  I didnt think so, not with a catchy title like that.  At least now the 3 people that read my blog will be aware of it.  The researchers followed 52,087 Norwegians aged 20-74 who were free of cardiovascular disease (CVD) for 10 years, then assessed the relationship of total cholesterol with total mortality, CVD mortality, and ischemic heart disease mortality (IHD).  (Just to be clear, CVD mortality signifies deaths from any disease of the cardiovascular system, while ischemic heart disease ers only to diseases involving restricted blood flow to the heart.)  Lets jump straight into the data then, shall we?  And another note:  since this study comes from Europe, the units for blood cholesterol are shown in mmol/L, rather than the mg/dL that we are used to.  The researchers classified the participants into four groups, based on their blood cholesterol.  Here are the converted unit values in mg/dL for the four groups...  <193, 193-229, 230-269, and >270


First, the least shocking data.  This graph compares the association between cholesterol levels and death from ischemic heart disease.  For the men, it looks like theres not much variation.  Deaths from heart disease rose slightly along with cholesterol levels, but nothing dramatic.  Women, on the other hand, yielded a much more interesting result.  Clearly, by a LARGE margin, cholesterol below 193 mg/dL was most predictive of death from heart disease.  All other groups, including the group with cholesterol over 270 mg/dL, showed significantly lower risk.  Yes, seriously.  On to the next graph!




This one here shows the association between cholesterol and cardiovascular disease, or CVD, which includes heart disease with stroke and any other disease of the cardiovascular system.  Again, lets begin with the men.  The lowest risk appears to lie in those with total cholesterol between 193 and 229 mg/dL, but a close second is the next range up, from 230 to 269.  If you know your erence ranges, you know that anything over 200 is considered dangerous.  Does anybody ever bother to check why this is considered dangerous, or do we just accept it without question??  Clearly, the data from this study suggests that a cholesterol level in men between 193 and 269 is optimal for CVD prevention.  As for women... oops, looks like they screwed up the data there!  They must have it backwards!  Except they dont... yes, the data shows that if youre a woman, the higher your cholesterol is, the lower your risk of death from CVD.  Id repeat it, but Ill be doing that again shortly.  Read on to all-cause mortality!


Here we are, all-cause mortality... the only statistics that really matter.  Deaths from IHD or CVD are cool, but not nearly as cool as all-cause mortality.  This one cuts through the bullshit.  Its not your risk of dying from one disease that really matters, its your risk of dying overall.  So, for men... the group with the HIGHEST risk of dying overall had the LOWEST cholesterol (below 193 mg/dL).  Even those with a cholesterol level over 270 fared better.  The sweet-spot, protective level here was shown to be 193-229, a level that, based on the current erence ranges, will likely get you prescribed a statin drug for being too high!  Its just not right I tell ya.  And for the women, we see another complete inverse relationship between blood cholesterol and all-cause mortality.  High cholesterol appears to be protective for the ladies!  Maybe I could incorporate that into a pickup line somehow... but I digress.

So, does this prove anything?  No.  Not really.  Although it happens to be in accordance with what I believe, its all just observation.  But this isnt the only study to show this kind of trend, just the most recent; there are at least 20 others like it if you just follow that link.  And it certainly makes a strong case for women... having low cholesterol, in the healthy erence range, mind you, just appears to be straight up deadly!  Despite the studys inability to conclusively prove anything, that didnt stop the researchers from letting loose a little on the drug industry.  And I quote from the conclusion of the paper... "Many individuals who could otherwise call themselves healthy struggle conscientiously to push their cholesterol under the presumed danger limit, coached by health personnel, personal trainers, and caring family members.  Massive commercial interests are linked to drugs and other remedies marketed for this purpose."  That may not seem so harsh, but for a group of researchers to say this and imply that massive commercial interests are wrongly influencing the clinical guidelines... thats a pretty strong statement.  And I agree wholeheartedly.  The guidelines need to be reassessed.

What does this mean, though, if having high cholesterol isnt a bad thing?  What are the implications?  Well, for one, maybe it will get people off these ridiculous statin drugs.  But even more significant, to me, are the implications for saturated fat consumption.  These days, everyone just "knows" saturated fat is bad.  But if I asked you, could you tell me why?  The standard answer is, because saturated fat raises your blood cholesterol.  Well... um... so what?  If you step outside of this cholesterol=bad paradigm for a while, things start to look a bit different.  What else is known about saturated fat?  Well, if you eat more of it, it makes up more of your cell membranes, and its highly resistant to oxidative damage.  So thats good, it protects your cells.  And... short-chain saturated fats like butyric acid, found in butter, are burned perentially as fuel and promote proper immune function.  And... saturated fats enhance calcium absorption, along with all the fat-soluble vitamins (A, D, E, K).  And dont forget, if youre a woman, having high cholesterol appears to be beneficial.  Wait a minute... could saturated fat be... healthy!?  So much for a French paradox...

Meals high in saturated fat (SAFA), as opposed to monounsaturated fat (MUFA), may impair artery function. That was the finding of a small study published in the December issue of Diabetes Care:

Differential Effects Of Two Different Isoenergetic Meals One Rich In Saturated And One Rich In Monounsaturated Fat On Endothelial Function In Subjects With Type 2 Diabetes Mellitus, Diabetes Care, December 2008

After 33 participants with type 2 diabetes consumed either a meal high in saturated fat (butter), or high in monounsaturated fat (olive oil), (meals had the same number of calories) their artery function was assessed.

Flow-mediated dilation (FMD):

• Declined by 16.7% after the saturated-fat-rich meal
  
• Increased by 5.2% after the monounsaturated-fat-rich meal

FMD measures the relaxation of an artery due to increased blood flow. FMD is a marker for heart disease risk. As FMD decreases, blood flow is impaired.

The authors concluded:

"Consumption of an SAFA-rich meal is harmful for the endothelium, while a MUFA-rich meal does not impair endothelial function in subjects with type 2 diabetes."

________

Often, studies investigate the effect of a particular food or food group, for example whole grains or processed meat, with its impact on developing diabetes. A study appearing in the September issue of Diabetes Care instead investigated the effect of multiple food groups.¹

It found:

"Multiple food groups collectively influence type 2 diabetes risk beyond that of the individual food groups themselves."

The food group that was associated with a decreased risk for diabetes (15% lower risk) included (not surprisingly) whole grains, vegetables (especially leafy greens), fruit, nuts and seeds, low-fat dairy foods, and coffee.

The food group that was associated with an increased risk for diabetes (18% greater risk) included red meat, processed meat, high-fat dairy foods, ined grains, and soda.

Interestingly, tomatoes and beans were part of the group that increased diabetes risk. The authors speculated that consumption of these foods may lect a less-than-nutritious diet, since theyre often found in highly-processed, high-fat convenience foods such as pizza and tacos.

In this study, no individual food group was associated with diabetes risk.

Participants were 5,011 White, Black, Hispanic, and Chinese-American men and women who took part in the Multi-Ethnic Study of Atherosclerosis (MESA).
________
¹ Dietary Patterns and Risk of Incident Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)

You may be shocked by the title of this post.  Have I changed my tune?  Am I finally giving up meat and going vegan??  Fear not, my friends, its simply a catchy title I used to draw you in. But it is the topic of an article I read today entitled "Vegetarians have longer life expectancy than meat eaters, study finds".  The study theyre erring to is one that followed 96,000 Canadian citizens, thousands of which were Seventh-day Adventists, who are vegetarians (supposedly).  The study isnt yet complete, but the preliminary results were reported at last weekends Food and Nutrition Conference and Exposition (FNCE) in Philadelphia.  Although I was in attendance at the conference, I did not see the presentation on this Seventh-day Adventist study.  I would have loved to be there, but instead I chose to see a lecture on food blogging, which, incidentally, I am doing right now.  Unfortunately I couldnt be everywhere at once... and Im fresh out of time travel crystals.


So I was happy to come across this article today and find out what I missed.  Heres the lowdown... Seventh-day Adventist men lived on average 9.5 years longer than other men, and women lived on average 6.1 years longer than other women.  Thats a pretty significant chunk of extra life.  But is it the vegetarian diet?  Or is is something else that keeps them truckin?  Maybe we should learn a little more about these Adventists...


What is a Seventh-day Adventist?
According to Wikipedia, the Seventh-day Adventist church is a Protestant Christian denomination that really loves Saturday, among other things.  Adventists abstain from secular work on Saturdays, and spend their day resting, hanging with the family, going on hikes, doing charitable work, and just generally taking it easy.  Many Adventists will meet after sundown on Friday night for worship to begin their Sabbath (Saturday). 


Interestingly, though, according to Wikipedias sources, only about 35% of Seventh-day Adventists actually eat a vegetarian diet... what gives?? 


Okay, so check this out.  There are several reasons for these long lifespans that have nothing to do with vegetarianism.

1.  The church strongly discourages smoking.
Smokers die.  And they die younger than everyone else.  The life expectancy for a smoker in the United States is about 64 years... 14 years younger than the national average (1).  Even former smokers who quit experience significant life extension.  One study found the following:  "Life expectancy among smokers who quit at age 35 exceeded that of continuing smokers by 6.9 to 8.5 years for men and 6.1 to 7.7 years for women."  Even quitting at age 65 adds years back onto your life (2).  But we dont have to stop there...

2.  The church discourages alcohol consumption.
To be fair, moderate alcohol consumption is associated with longevity (3).  But excessive alcohol consumption clearly is not.  In fact, according to this article, alcoholism takes 10-12 years off of ones life (4).  And in Canada, where this Adventist study is being conducted, about 7.7% of ALL deaths from ages 0-64 are due to alcohol (5).  No these Adventists arent your typical Canadian folk.  I find it highly unlikely that any of these people were binge-drinking on Sabbath.

3.  They take Saturday off.
Stress is bad.  We all know it.  If youre spreading yourself too thin, theres never enough time to get things done, you go home feeling like all you have time to do is sleep and get up for the next day and do it all over again... that stuff will kill ya (6).  But not our Seventh-day Adventists.  Because on their seventh day, they relax.  They rest their mind and their body, and they do it because God said so... and God was right.  A day of de-stressing is no doubt beneficial for longevity, regardless of why you do it.

4.  A sense of community.
Seventh-day Adventists are typically active in their local church.  They may spend Friday night and part of their Saturday at church, where they worship, sing, and hang with their buddies.  They typically have strong family structure as well.  In short, they have strong ties to those around them, and thats an important factor in health and longevity.

Is the picture starting to look a little different at this point??


Soooo conclusion.  Despite that articles willingness to use the terms "Adventist" and "vegetarian" interchangeably as if theyre the same thing, theyre clearly not.  There is a lot more going on here than just a propensity to be vegetarian.  There are a whole host of other reasons why these people live long lives, and they have nothing to do with abstaining from meat.  No smoking, no drinking, rest on the weekends, and a strong sense of community.  Thats more of a key to a long, healthy life than a vegetarian diet will ever be.

But I want to hear from you.  What are your thoughts on this article?  Agree or disagree? 

Happier than......

.... a statistician in a care management data center.

.... a diabetes care manager in a crowded pastry shop.

.... a specialist physician at a RUC meeting.

.... a bank robber at a RAC audit.

.... a potato chip vendor outside a medicinal marijuana store

.... a lap band manufacturer at a Governor Christie news conference.

.... a vampire at a glucose meter testing lab.

.... spandex at a wellness vendor trade association meeting.

.... a bankruptcy lawyer at an Accountable Care Organization convention.

.... a CMS official watching a National Geographic Channel special on sloths.

.... a health economist at a fog-machine quality assurance testing facility.

.... a personal injury attorney reading an electronic health record.

.... an ADHD patient with a Twitter account.

and last but not least.....

.... a skeptic discovering the Disease Management Care Blog.

The DMCB invites readers to submit their own.

Researchers at Duke University recently reported that aerobic exercise was better than resistance training (e.g. exercising with weights) for reducing belly fat:



The Effects of Aerobic versus Resistance Training on Visceral and Liver Fat Stores, Liver Enzymes and HOMA from STRRIDE AT/RT: A Randomized Trial, American Journal of Physiology, August, 2011



Their study involved 249 subjects (155 completed). They were between 18 and 70 years old, overweight, sedentary, and with moderately high LDL (130-190 mg/dL) or moderately low HDL (≤40 mg/dL men, ≤45 mg/dL women).



Subjects were randomly assigned to one of three groups for 8 months:

1. Resistance Training (RT) - 3 days/wk, 8 exercises, 3 sets/exercise, 8-12 repetitions/set.
   
   
2. Aerobic Training (AT) - about 19.2 km/wk (12 miles/wk).
   
   
3. Full Aerobic Training plus full Resistance Training (AT/RT).

Findings:



Aerobic Training led to significant reductions in:

• Liver fat
  
  
• Visceral fat (fat between abdominal organs, called belly fat)
  
  
• Liver enzymes (ALT)
  
  
• Insulin resistance (HOMA)
  
  
• Both total and subcutaneous abdominal fat

Resistance Training led to significant reductions in:

• Subcutaneous abdominal fat

RT did not significantly improve the other variables.



When it came to using energy, aerobic training burned 67% more calories than resistance training.



Results of AT plus RT were not different from AT alone.



The authors concluded:

"For overweight and obese individuals who want to reduce measures of visceral fat and fatty liver infiltration and improve [insulin resistance] and [liver enzymes], a moderate amount of aerobic exercise is the most time efficient and effective exercise mode."

Lead author Cris Slentz, PhD, added:¹

"When it comes to increased health risks, where fat is deposited in the body is more important than how much fat you have."



"Resistance training is great for improving strength and increasing lean body mass. But if you are overweight, which two-thirds of the population is, and you want to lose belly fat, aerobic exercise is the better choice because it burns more calories."



"What really counts is how much exercise you do, how many miles you walk, and how many calories you burn. If you choose to work at a lower aerobic intensity, it will simply take longer to burn the same amount of unhealthy fat."

________

¹ Want To Lose Belly Fat? Aerobic Exercise Beats Weights, Medical News Today, August 30, 2011