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Personalized health coaching helps reverse progression to diabetes

Goal-setting focused on exercise, nutrition, stress and sleep improves health

People with prediabetes who took part in a comprehensive health program to improve nutrition, exercise, stress and sleep were able to revert to normal blood glucose metabolism, reducing their risk for developing diabetes–a known risk factor for cardiovascular disease–according to a study to be presented at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.

The program, which focuses on promoting healthy behaviors and reducing cardiac risk, is unique because unlike others that tend to focus exclusively on exercise and nutrition it also integrates managing sleep and stress, the study authors said. Participation in the program seems to help prevent progression to diabetes and improve overall health, said Mariam Kashani, DNP, chief scientific director at Walter Reed National Military Medical Center in Bethesda, Maryland, and the study’s lead author.

Researchers examined data for 508 consecutive subjects in the Integrative Cardiac Health Project, an ongoing risk management program. Patients received a comprehensive assessment of their cardiovascular health along with personalized health recommendations with tailored goals–all in line with national preventive care guidelines–and then took part in 14 personalized in-person or telephonic coaching sessions with specialists in nutrition, exercise, sleep and stress management. Researchers examined the impact of the intervention on blood glucose levels and other key risk factors. Of the 107 participants who had prediabetes–when blood sugar is elevated but not high enough to be diagnosed as type 2 diabetes–at the start of the study, 49 percent were at normal blood glucose levels at the end of the 6-month study period irrespective of weight loss.

“Many more patients reverted to normal blood glucose than expected, especially if we consider that they were not necessarily losing weight,” Kashani said, adding that the program is a supplement to usual care. “This is important because prediabetes is a modifiable risk factor for cardiovascular disease.”

An estimated 86 million Americans have prediabetes. The main concern is that as many as 1 in 3 people with prediabetes will develop diabetes within five years if elevated blood glucose levels are not managed or reversed. The risk goes up with excess weight, inactive lifestyle and family history. Most people are unaware they have prediabetes especially because there are often no discernible symptoms, according to the Centers for Disease Control and Prevention.

On average, participants who were able to regain normal glucose metabolism lowered their fasting glucose level by 12 percent, or 13 milligrams, dropping from 105.4 to 92.4 milligrams of glucose per deciliter of blood.

“This is a big deal because we know that with each 5 milligrams per deciliter drop in blood glucose, there is a significant reduction in cardiovascular risk,” Kashani said. “Most importantly, they lowered their glucose levels below the threshold of 100 milligrams per deciliter when blood vessels start to become unhealthy.”

In addition, patients with prediabetes had significant improvements in blood pressure, fasting insulin, perceived stress levels, adherence to the Mediterranean diet, which is known to be heart protective, and reported feeling less tired. As a result, Kashani said that medication use was often reduced because it was no longer indicated at the same dose, though medication use was not tracked in the study.

A major limitation of the study is that it is observational and there is no comparison group–that is, everyone with prediabetes participated in the cardiovascular disease risk reduction program. However, Kashani said those who were able to revert to normal blood glucose levels also had significantly lower triglyceride levels at six months compared with others who remained prediabetic. Triglycerides are not only a measure of heart health, but in lifestyle medicine they are also a marker of patient compliance to behavioral change recommendations, according to authors. A study to compare this lifestyle intervention to usual care is underway.

Kashani said the findings confirm that focusing solely on diet and exercise can only get someone so far.

“By taking sleep and stress into account, we factor in important hormonal processes to better manage glucose,” she said. “When we are stressed, our bodies release extra glucose and when we are tired, we tend to make poor food choices. In this context, people often regain weight, and in doing so, they may revert back to worsening blood glucose levels.”

She adds it is one thing to educate people, but in order to help promote changes that are sustainable it is critical to look at the triggers and provide creative, practical tools such as food demonstrations, the introduction of 10-minute tension tamers, and using smartphones to set alarms as reminders for earlier bedtime.

“We meet patients where they are in their lives, and we emphasize small steps and practical tools,” Kashani said. “It’s not about waking up one day and making dramatic life changes but taking a step back and figuring out what the triggers are because maladaptive behaviors don’t happen on their own.”

Because prediabetes is a precursor to diabetes, programs to help modify and reduce risks among this population are urgently needed. Kashani said she is hopeful the Integrative Cardiac Health Project can be that model. She and others are using the program’s registry to study the sustainability of lifestyle change strategies over time. They are also initiating randomized-controlled trials to see how behavioral patterns correlate with biomolecular markers and genetics to develop more precise cardiovascular risk assessment tools.

The project is funded by the United States Army Medical Research and Materiel Command and includes a total of 770 patients.

The study, “Prediabetes Reversal Using a Novel Comprehensive Health Model,” will be presented by Kashani on March 14 at 1:30 p.m. PT/4:30 p.m. ET/8:30 p.m. UTC at the American College of Cardiology’s 64th Annual Scientific Session in San Diego. The meeting runs March 14-16.

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Spouse ‘more likely to increase exercise levels if other spouse does’
Past studies have suggested married individuals are more likely to eat a healthy diet if their spouse does. Now, a new study claims the same can be said for exercise.
Led by researchers from the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, the study reveals that if one spouse increases their physical activity, the other spouse is much more likely follow in their footsteps.

The team recently presented its findings at the American Heart Association’s EPI/Lifestyle 2015 Scientific Sessions in Baltimore, MD.

The Physical Activity Guidelines for Americans, set by the US Department of Health and Human Services, recommend that adults engage in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity each week.

A 2012 report from the Centers for Disease Control and Prevention (CDC), however, found that less than half of adults in the US meet these physical activity recommendations.

But the researchers say their findings suggest a potentially effective way of increasing exercise levels for some adults: counseling married couples on health together, rather than separately.

“When it comes to physical fitness, the best peer pressure to get moving could be coming from the person who sits across from you at the breakfast table,” says study co-author Laura Cobb, a doctoral student at Johns Hopkins.

“There’s an epidemic of people in this country who don’t get enough exercise,” she continues, “and we should harness the power of the couple to ensure people are getting a healthy amount of physical activity.”

Spouse 40-70% more likely to meet exercise recommendations if other spouse does

To reach their findings, Cobb and colleagues analyzed the medical records of 3,261 spouse pairs who were a part of the Atherosclerosis Risk in Communities Study (ARIC), which began in 1987.

From 1987-89, the spouse pairs had two medical visits that were conducted approximately 6 years apart. At each visit, the physical activity levels of each spouse were recorded, and the team compared these with the recommendations set in the Physical Activity Guidelines for Americans.

At the first visit, the team found that 33% of wives and 40% of husbands met physical activity recommendations.

On the second visit, however, a husband was 70% more likely to meet physical activity guidelines if his wife met the guidelines on the first visit, compared with husbands whose wives were less active.

In addition, a wife was 40% more likely to meet physical activity recommendations on the second visit if her husband met recommendations on the first visit.

Commenting on the team’s findings, Cobb says:

“We all know how important exercise is to staying healthy. This study tells us that one spouse could have a really positive impact on the other when it comes to staying fit and healthy for the long haul.”

This research builds on the findings of a previous study reported by Medical News Today in January, which found individuals were more likely to make healthy lifestyle changes – such as quitting smoking, increasing exercise or losing weight – if their partner did.

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Study shows strong link between adolescent obesity and high blood pressure

A recent study published in the American Journal of Hypertension has found that body mass index (BMI) in healthy adolescents has a statistically significant association with both systolic blood pressures (SBP) and diastolic blood pressures (DBP), and highlights the significance of the global trend of rapidly increasing adolescent obesity.

The study, led by Yaron Arbel, M.D., Department of Cardiology, Tel Aviv Medical Center, examined 715,000 Israeli adolescents, both male and female, aged 16-20, who had received medical exams from 1998-2011.

There was a statistically significant link observed between BMI and blood pressure, both of which saw significant annual increases during the study. The percentage of overweight adolescents increased from 13.2% in 1998 to 21% in 2011, while the percentage of adolescents with high blood pressure (SBP > 130mmHg) rose from 7% to 28% in males and 2% to 12% in females.

The association of BMI to blood pressure was more pronounced in females than males. While the reason for this is not immediately clear, researchers hypothesized that it may be attributable to certain hormonal factors.

“An important finding in our analysis is that BMI was positively associated with SBP and DBP in both the normal weight and overweight groups,” says Dr. Arbel. “This highlights the importance of BMI as a marker for cardiovascular health in all body types.”

Dr. Arbel feels that the study highlights the need to address childhood obesity: “Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. They are much more likely to be obese as adults and are consequently more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, numerous types of cancer, and osteoarthritis.”

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Best exercises during pregnancy: the top 5

Congratulations on your pregnancy! Now you can sit back, relax and put your feet up for the next 9 months, right? Not so fast! Attitudes and beliefs about prenatal exercise have drastically changed over the past 20 years. No longer is pregnancy viewed as a time to sit, watch TV and eat chocolate.

These days, moms can actually maintain and improve their fitness levels while pregnant. And exercise provides many numerous benefits such as a boost in your mood and energy levels, helps you sleep better, helps prevent excess weight gain and increases your stamina and muscle strength. You cannot lose!

Regular exercise during your pregnancy can improve not only your heart health and boost your energy, but also improves your overall health. Maintaining a healthy body and healthy weight gain can help reduce common pregnancy complaints and discomforts like lower back pain, fatigue and constipation and can even help with shortening your time during labor by strengthening your endurance.

First, consult your health care provider to check that it is okay to exercise. If you have been participating in a regular exercise regimen and are having a healthy pregnancy, there should not be a problem continuing with your regimen in moderation. You may have to modify your exercise according to your trimester of pregnancy.

If you have not participated in an exercise regimen three times a week before getting pregnant, do not jump into a new, strenuous activity. Start out with a low-intensity activity and gradually move to a higher activity level.

Moderate exercise during pregnancy “may give your baby a healthier start”

The best type of exercise during pregnancy:

pregnant woman and man walking dog
A stroll around the neighborhood is a great way to start exercising during pregnancy. Your heart rate will increase steadily without too much impact on your knees and ankles.
  • Increases your heart rate steadily and improves your heart circulation
  • Keeps you flexible and limber
  • Manages your weight gain by burning calories
  • Prepares your muscles for labor and birth
  • Will not cause you to push your body too hard.

Research shows that healthy pregnant women who exercise during their pregnancy may:

  • Have less risk of preterm labor and birth
  • Have a shorter labor process
  • Be less likely to need pain relief
  • Recover from childbirth faster.

Regular, moderate exercise not only gives you a healthier pregnancy, it may also give your baby a healthier start. Research shows that when pregnant women exercise, their developing babies have a much lower heart rate. Babies of active moms may also have a healthier birth weight.

Experts recommend that you exercise for 30 minutes a day, on most days. Most exercises are safe to perform during pregnancy, as long as you exercise with caution and do not overdo it.

Your pregnancy exercise regimen should strengthen and condition your muscles. Always begin by warming up for 5 minutes and stretching for 5 minutes. Following your choice of exercise, finish your regimen with 5-10 minutes of gradually slower exercise that ends with gentle stretching.

Use common sense:

  • Avoid exercise that involves lying on your stomach or flat on your back after the first trimester of pregnancy
  • Stay well hydrated and drink plenty of fluids before, during and after you exercise
  • Avoid overheating and humidity, especially during the first trimester when the fetus is undergoing its most important growth and development
  • Stop exercising if you feel fatigued, develop persistent pain or experience any vaginal bleeding; check with your health care provider if regular contractions occur more than 30 minutes after exercise (possibly a sign of pre-term labor)
  • Avoid heavy weightlifting and any activities that require straining
  • Avoid exposure to extremes of air pressure, as in high altitude exercise (unless you are accustomed to it) or scuba diving
  • Do not increase the intensity of your workout beyond pre-pregnancy intensity level
  • Eat small, frequent meals throughout the day. Sedentary pregnant women need about 3,000 calories per day during the second and third trimesters; if you are physically active, your caloric needs will be higher to make up for the calories burned up during your exercise regimen.

The safest and most productive activities to perform during your pregnancy are brisk walking, swimming, indoor stationary cycling, prenatal yoga and low-impact aerobics (taught by a certified aerobics instructor).

These activities carry little risk of injury, benefit your entire body, and can be continued until the birth of your baby. Other activities such as jogging can be done in moderation. You might want to choose exercises or activities that do not require great balance or coordination, especially later in your pregnancy.

Basic exercise guidelines:

  • Wear loose-fitting, comfortable clothes, as well as a good support bra
  • Choose shoes that are designed for the type of exercise you choose. Proper shoes are your best protection against injury
  • Exercise on a flat, level surface to avoid injury
  • Finish eating at least one hour before exercising
  • Get up slowly and gradually to prevent dizziness
  • Never exercise to the point of exhaustion. If you cannot talk normally while exercising, you are probably over exerting yourself, and you should slow down your activity.

Physical changes that might affect your ability to exercise

Physical changes during your pregnancy will create extra demands on your body. Keeping in mind the changes listed below, remember you need to listen to your body and adjust your activities or exercise regimen as necessary.

  • Your developing baby and other internal changes require more oxygen and energy
  • Hormones (relaxin) produced during pregnancy cause the ligaments that support your joints to stretch, increasing the risk of injury
  • The extra weight and the uneven distribution of your weight alters your center of gravity. The extra weight also puts stress on joints and muscles in the lower back and pelvic area, and makes it easier for you to lose your balance.

If you have a medical condition, such as asthma, heart disease, hypertension or diabetes, exercise may not be advisable. Again, consult with your health care provider before beginning any exercise regimen.

Exercise may also be harmful if you have a pregnancy-related condition such as:

  • Vaginal bleeding or spotting
  • Low placenta (low-lying or placenta previa)
  • Threatened or history of recurrent miscarriage
  • Previous premature births or history of early labor
  • Weak cervix.

Talk with your health care provider before beginning an exercise program. Your health care provider can also suggest personal exercise guidelines, based on your medical history.

The top 5 best pregnancy exercises

Brisk walking

Even if you have never exercised a day in your life, a quick stroll around the neighborhood is a great way to start. You will get a cardiovascular workout without too much impact on your knees and ankles, and you can do it almost anywhere and at any time throughout the entire 9 months. Walk with your partner, walk your dog, everybody benefits!

pregnant woman in swimming pool
Swimming is the ideal exercise during pregnancy and gives you the added bonus of feeling weightless!

Safety tip:

As your baby grows, your center of gravity will change, and you can lose your sense of balance and coordination. Walk on smooth surfaces; watch out for potholes, rocks and other obstacles. Remember to wear supportive sneakers.

Swimming

If ever there was an ideal exercise for during pregnancy, it is swimming. There is zero chance of falling on your abdomen and injuring your baby.

Exercising in water gives you a better range of motion without putting pressure on your joints. Even in your ninth month, you can swim, walk, do aerobics or dance in the water. Water aerobics is great cardio. Have fun!

Safety tip:

While swimming, choose a stroke that feels comfortable and that does not strain or hurt your neck, shoulders, or back muscles. For example, the breaststroke is a good choice because you do not have to rotate your torso or belly. Use the kickboard to help strengthen your leg and buttock muscles.

Do be careful when entering the water. Use the railing for balance and to prevent slipping. Avoid diving or jumping into the water as this could cause too much abdominal impact. To avoid overheating, extremely warm pools, steam rooms, hot tubs, and saunas are a no-no!

Stationary cycle

Take a load off your legs! Cycling on a stationary bike is generally safe even if you are just starting an exercise program.

Cycling is a beneficial way to increase your heart rate without stressing your joints. As your belly grows, you can raise the handlebars for greater comfort. The American Pregnancy Association states that riding a stationary bike is safe during pregnancy. The bike can help to support your weight, and although your changing center of gravity makes you more likely to fall on a regular bicycle, a stationary bike reduces that chance.

Yoga

Prenatal yoga classes keep your joints limber and help you maintain flexibility. Yoga strengthens your muscle system, stimulates blood circulation, and helps you relax. You can use these techniques from your yoga class to stay calm and have a little more control during the labor process.

Safety tip:

As your pregnancy progresses, skip positions that really challenge your balance. In your second trimester, steer clear of poses that require you to lie flat on your back – as your baby grows, and your uterus gets heavier, it can place too much pressure on major veins and arteries and decrease the blood flow to your heart.

Also, be careful not to overstretch. Pregnant women produce more relaxin, a hormone that increases flexibility and joint mobility, it is important to know your limits and hold back slightly when stretching.

Low-impact aerobics

What is the difference between high and low impact aerobics? Overall, aerobic exercise strengthens your heart and lungs and helps maintain muscle tone. Low-impact aerobics excludes jumping, high kicks, leaps, or fast running. You keep one foot on the ground at all times, so you limit the amount of stress on your joints and maintain balance.

This type of aerobic exercise will also protect your pelvic floor. Too much jumping up and down and bouncing can weaken your pelvic floor muscles and increase your chances of urine leakage.

Consider joining an aerobics class geared for pregnant women. This way you can enjoy the company of other pregnant women and have the expertise of an instructor that is trained to modify exercises for pregnant clients as your belly grows.

If you have already joined a regular aerobics class, notify your instructor so they can modify or advise elimination of certain movements and poses that would not be beneficial for you and your baby.

Stop exercising and consult your health care provider if you:

  • Feel pain
  • Have abdominal, chest, or pelvic pain
  • Notice an absence of fetal movement
  • Feel faint, dizzy, nauseous, or light-headed
  • Feel cold or clammy
  • Have vaginal bleeding
  • Have a sudden gush of fluid from the vagina or a trickle of fluid that leaks steadily (when your bag of “water” breaks, also called a rupture of the amniotic membrane)
  • Notice an irregular or rapid heartbeat
  • Have sudden swelling in your ankles, hands, face, or experience calf pain
  • Have increased shortness of breath
  • Have persistent contractions that continue after rest
  • Have difficulty walking.

Regular exercise will keep you and your baby healthy while staying fit and enjoying your pregnancy!

 

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Better midlife fitness may slow brain aging

People with poor physical fitness in their 40s may have lower brain volumes by the time they hit 60, an indicator of accelerated brain aging, according to new research presented at the American Heart Association EPI/Lifestyle 2015 meeting.

“Many people don’t start worrying about their brain health until later in life, but this study provides more evidence that certain behaviors and risk factors in midlife may have consequences for brain aging later on,” said Nicole L. Spartano, Ph.D., lead author and a postdoctoral fellow at the Boston University School of Medicine.

A subset of 1,271 participants from the Framingham Offspring Study participated in exercise treadmill testing in the 1970s, when their average age was 41. Starting in 1999, when their average age was 60, they underwent magnetic resonance imaging (MRI) of their brains as well as cognitive tests. The participants did not have heart disease or cognitive problems at the beginning of the study, and none were taking medication that alters heart rate.

In individuals with low fitness levels, the blood pressure and heart rate responses to low levels of exercise are often much higher than in individuals with better fitness.

“Small blood vessels in the brain are vulnerable to changes in blood pressure and can be damaged by these fluctuations,” Spartano said. “Vascular damage in the brain can contribute to structural changes in the brain and cognitive losses. In our investigation we wanted to determine whether exaggerated blood pressure fluctuations during exercise were related to later structural changes in the brain.”

The researchers found:

  • People who had a lower fitness level or greater increase in diastolic blood pressure (bottom number) or heart rate a few minutes into the low-intensity treadmill test (2.5 miles an hour) had smaller brain tissue volume later in life.
  • People who had a larger increase in diastolic blood pressure during low-intensity exercise also performed more poorly on a cognitive test for decision-making function later in life.

Poor physical fitness could be associated with accelerated brain aging.

“For every 3.4 units lower exercise capacity, every 7.1 mm Hg higher exercise diastolic blood pressure, and for every 8.3 beats/minute higher exercise heart rate in midlife, these effects are approximately equivalent to an additional 0.5 years of brain aging,” Spartano said.

Apart from the exercise tests, a higher resting systolic blood pressure (top number) at age 40 was associated with a smaller frontal lobe volume and a greater volume of white matter hyperintensity (an indicator of loss of blood flow with aging) on the later brain MRIs.

Promotion of midlife physical fitness may be an important step towards ensuring healthy aging of the brain in the population, researchers said.

“It will be interesting to follow up with these participants in another 10 years to determine how many developed dementia, and if that may be related to their fitness or exercise blood pressure or exercise heart rate in midlife,” Spartano said.

Co-authors are: Jayandra J. Himali, Ph.D.; Alexa S. Beiser, Ph.D.; Charles DeCarli, M.D.; Ramachandran S. Vasan, M.D.; and Sudha Seshadri, M.D.

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New treadmill performance test ‘predicts long-term risk of death from all causes’

According to a new study by cardiologists at Johns Hopkins Medicine in Baltimore, MD, analyzing the ability of patients to exercise on a treadmill at increasing speed and incline could help to predict their risk of dying over a decade.

Although some exercise-based risk scoring systems to predict short-term risk of death are already in use, they can only be applied to patients with diagnosed heart disease or other cardiovascular best-weight-loss-slimming-clinic-medicine-treatment-islamabad-lahore-karachi-pakistan-problems, and incorporate results from electrocardiograms (EKGs) with other variables.

Publishing the results of their work in the journal Mayo Clinic Proceedings, the Johns Hopkins cardiologists claim to have developed an algorithm – called the FIT Treadmill Score – which can measure long-term risk of death in anyone and is based solely on treadmill performance.

“The notion that being in good physical shape portends lower death risk is by no means new, but we wanted to quantify that risk precisely by age, gender and fitness level, and do so with an elegantly simple equation that requires no additional fancy testing beyond the standard stress test,” says lead author Dr. Haitham Ahmed, a cardiology fellow at the Johns Hopkins University School of Medicine.

As well as the patient’s age and gender, the FIT Treadmill Score takes into account the peak heart rate reached during intense exercise and their ability to tolerate physical exertion.

This tolerance of physical exertion is assessed using a measure known as “metabolic equivalents” (METs). An activity such as slow walking equals two METS, the authors explain, compared with eight METs for running.

Data from 58,020 individuals aged 18-96 who underwent exercise stress tests between 1991 and 2009 were analyzed by the John Hopkins team when developing their algorithm.

Tracking how many participants died from any cause over the next decade, the researchers found that – among people of the same age and gender – fitness level measured by METs and peak heart rate during exercise were the most reliable predictors of death and survival, even when family history and factors like diabetes were taken into consideration.

The score ranged from negative 200 to positive 200. Participants who score above 0 have low mortality risk, while those with a negative score face the highest risk of death.

FIT is ‘cost-effective and simple to calculate’

The researchers say that because the score is easy to calculate and costs nothing beyond the cost of the treadmill test itself, it should be used for the millions of patients undergoing cardiac stress testing in the US each year.

Exercise stress tests are commonly used to inform treatment decisions and decide whether patients require invasive cardiac tests. In these tests, the patient walks on a treadmill that is increasing in speed and incline. The test is stopped once the person becomes exhausted or develops chest pain, dizziness or abnormalities in their heart rhythm.

EKG readings from the test are used to determine whether angiography – an invasive examination of the interior of the heart’s main blood veins – is required. If abnormalities in the EKG are detected, then the patient is referred for angiography. If there are no EKG abnormalities then no further testing is required.

“Stress test results are currently interpreted as ‘either/or’ but we know that heart disease is a spectrum disorder,” Dr. Ahmed considers. “We believe that our FIT score reflects the complex nature of cardiovascular health and can offer important insights to both clinicians and patients.”

“We hope the score will become a mainstay in cardiologists’ and primary clinicians’ offices as a meaningful way to illustrate risk among those who undergo cardiac stress testing and propel people with poor results to become more physically active,” says senior study author Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.

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Study shows ‘feast and famine’ DOES help you live longer

Think of it as interval training for the dinner table. University of Florida Health researchers have found that putting people on a feast-or-famine diet may mimic some of the benefits of fasting, and that adding antioxidant supplements may counteract those benefits.

Fasting has been shown in mice to extend lifespan and to improve age-related diseases. But fasting every day, which could entail skipping meals or simply reducing overall caloric intake, can be best-weight-loss-slimming-clinic-medicine-treatment-islamabad-lahore-karachi-faisalabad-peshawar-pakistanhard to maintain.

“People don’t want to just under-eat for their whole lives,” said Martin Wegman, an M.D.-Ph.D. student at the UF College of Medicine and co-author of the paper recently published in the journal Rejuvenation Research. “We started thinking about the concept of intermittent fasting.”

Michael Guo, a UF M.D.-Ph.D. student who is pursuing the Ph.D. portion of the program in genetics at Harvard Medical School, said the group measured the participants’ changes in weight, blood pressure, heart rate, glucose levels,cholesterol, markers of inflammation and genes involved in protective cell responses over 10 weeks.

“We found that intermittent fasting caused a slight increase to SIRT 3, a well-known gene that promotes longevity and is involved in protective cell responses,” Guo said.

The SIRT3 gene encodes a protein also called SIRT3. The protein SIRT3 belongs to a class of proteins called sirtuins. Sirtuins, if increased in mice, can extend their lifespans, Guo said. Researchers think proteins such as SIRT3 are activated by oxidative stress, which is triggered when there are more free radicals produced in the body than the body can neutralize with antioxidants. However, small levels of free radicals can be beneficial: When the body undergoes stress – which happens during fasting – small levels of oxidative stress can trigger protective pathways, Guo said.

“The hypothesis is that if the body is intermittently exposed to low levels of oxidative stress, it can build a better response to it,” Wegman said, who recently completed a two-year pre-doctoral fellowship at UF supported by a National Institutes of Health Clinical and Translational Science Award.

The researchers found that the intermittent fasting decreased insulin levels in the participants, which means the diet could have an anti-diabetic effect as well.

The group recruited 24 study participants in the double-blinded, randomized clinical trial. During a three-week period, the participants alternated one day of eating 25 percent of their daily caloric intake with one day of eating 175 percent of their daily caloric intake. For the average man’s diet, a male participant would have eaten 650 calories on the fasting days and 4,550 calories on the feasting days. To test antioxidant supplements, the participants repeated the diet but also included vitamin C and vitamin E.

At the end of the three weeks, the researchers tested the same health parameters. They found that the beneficial sirtuin proteins such as SIRT 3 and another, SIRT1, tended to increase as a result of the diet. However, when antioxidants were supplemented on top of the diet, some of these increases disappeared. This is in line with some research that indicates flooding the system with supplemental antioxidants may counteract the effects of fasting or exercise, said Christiaan Leeuwenburgh, Ph.D., co-author of the paper and chief of the division of biology of aging in the department of aging and geriatric research.

“You need some pain, some inflammation, some oxidative stress for some regeneration or repair,” Leeuwenburgh said. “These young investigators were intrigued by the question of whether some antioxidants could blunt the healthy effects of normal fasting.”

On the study participants’ fasting days, they ate foods such as roast beef and gravy, mashed potatoes, Oreo cookies and orange sherbet – but they ate only one meal. On the feasting days, the participants ate bagels with cream cheese, oatmeal sweetened with honey and raisins, turkey sandwiches, apple sauce, spaghetti with chicken, yogurt and soda – and lemon pound cake, Snickers bars and vanilla ice cream.

“Most of the participants found that fasting was easier than the feasting day, which was a little bit surprising to me,” Guo said. “On the feasting days, we had some trouble giving them enough calories.”

Leeuwenburgh said future studies should examine a larger cohort of participants and should include studying a larger number of genes in the participants as well as examining muscle and fat tissue.

Guo, Wegman and their fellow authors developed the study with UF Institute on Aging faculty members Stephen Anton, Ph.D., and Leeuwenburgh, as well as UF Clinical and Translational Institute faculty and staff including study dietician Meena Shankar. The endeavor was as a part of a class in the UF M.D.-Ph.D. program that is designed to teach students to bridge the gap from clinical research to bedside medicine, during which students design a clinical trial based at the UF Clinical Research Center.

“As we go through the study design and work out the basic science and clinical aspects, we marry those together and have a final product of an Institutional Review Board-approved clinical trial,” said Mark L. Brantly, M.D., a professor in the department of medicine, senior author on the paper, and leader of the class project. “These students are remarkable in their motivation, maturity and intellectual capacity. I’m amazed at what they are able to accomplish, such as working in a team, sharing a workload and connecting with people.”

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More than 2 hours of TV a day increases high blood pressure risk in children by 30 percent

A study on European children concludes that spending more than two hours a day in front of a screen increases the probability of high blood pressure by 30%. The article also points out that doing no daily physical activity or doing less than an hour a day increases this risk by 50%.

TV and High Blood Pressure Risk
A study on European children concludes that spending more than two hours a day in front of a screen increases the probability of high blood pressure by 30%. The article also points out that doing no daily physical activity or doing less than an hour a day increases this risk by 50%.
Credit: SINC

For years now scientific literature has associated watching the television with a sedentary lifestyle and obesity in young people. Now research led by the Universities of Zaragoza (Unizar) and São Paulo (Brazil) reveal the relationship between this habit and a greater risk of developing high blood pressure.

“The study shows the number of new high blood pressure cases and the connection between physical activity and different sedentary behaviours with the risk of high blood pressure in European children,” explains Augusto César F. de Moraes, a Brazilian researcher who collaborates with the Unizar group and lead author of the article, to SINC.

The scientists based their conclusion on data from the study on ‘Identification and Prevention of Dietary- and Lifestyle-induced Health Effects in Children and Infants’ (IDEFICS), gathered over two years in 5,221 children from eight European countries (Spain, Germany, Hungary, Italy, Cyprus, Estonia, Sweden and Belgium), who were between 2 and 10 years old at the beginning of the study.

The results, published recently in the International Journal of Cardiology, show that the cumulative incidence of high blood pressure in this population during the two years analysed is high: 110 in 1,000. “High blood pressure can cause cardiovascular problems later in life,” adds F. de Moraes. “For example, it increases the risk of ischemic heart disease“.

The authors state that children who are sedentary for more than two hours a day, in front of the television, computers or videoconsoles, run a 30% greater risk of developing high blood pressure. “The figures are worrying, given that sedentary behaviours are common in infancy and subsequently, later in life”.

Among the non-communicable diseases, high blood pressure has a high incidence in adults. Different studies have demonstrated that the levels of arterial pressure in infancy and adolescence have an enormous impact on developing high blood pressure as an adult.

More than one hour a day of exercise

To beat this condition, experts recommend that young people carry out physical activity for more than 60 minutes a day, and advise that sedentary activities last no longer than two hours a day.

Similarly, the researchers have observed that not doing an hour of physical activity a day increases the risk of high blood pressure by 50%. “Scientific evidence indicates that physical activity is a powerful vasodilator. Therefore, the rate of oxygenation of the heart increases, and at the same time, decreases arterial pressure,” concludes F. de Moraes.


Older people and eating disorders: not ‘just a teenager’s problem’

Eating disorders are often portrayed as a disease that only affects the young and privileged, yet this is not the case. Eating disorders can affect anyone at any time, regardless of age, gender identity, race, ethnicity, sexuality or cultural background.

While eating disorders are often considered to be a “teenager’s problem,” older people can also be affected by these diseases.

Not only are they susceptible to eating disorders, but there are a number of unique problems that are experienced by this social group.

“We have heard of cases where physicians have told patients that they should have ‘grown out of’ eating disorders,” Prof. Cynthia M. Bulik told Medical News Today. “Or that they are ‘too old’ to immigration-consultant-lawyer-canadian-australian-newzealand-student-visas-karachi-lahore-islamabad-peshawar-faisalabad-pakistan-be suffering fromanorexia, bulimia or binge-eating disorder.”

In this Spotlight feature, we investigate precisely how older people can be affected by eating disorders, what unique problems they face and what is currently being done to raise awareness of this issue.

What are eating disorders?

Eating disorders are serious conditions that can have a significant impact on an individual’s physical and emotional health, as well as affecting their productivity and their relationships.

These diseases have the potential to be life-threatening, and anyone that develops an eating disorder should seek professional help. The National Institute of Mental Health (NIMH) state that people with anorexia nervosa are 18 times more likely to die early, compared with people of similar ages in the general population.

According to the National Eating Disorders Association (NEDA), around 20 million women and 10 million men in the US experience a clinically significant eating disorder at some point in their lives.

Common forms of eating disorder include:

  • Anorexia nervosa: a disorder characterized by a distorted perception of body weight and a significant fear of gaining weight. People with anorexia nervosa often go to extreme measures to lose weight or prevent weight gain
  • Bulimia nervosa: a disorder characterized by people eating a lot of food (bingeing) and then attempting to get rid of the extra calories in unhealthy ways. This can take the form of “purging,” through self-induced vomiting or the misuse of laxatives, for example
  • Binge-eating disorder: a condition whereby unusually large amounts of food are frequently consumed, accompanied by a compulsion to do so.

Each of these conditions is associated with food and weight to varying degrees. However, such is the complexity of these disorders that they usually arise from a combination of factors – biological, interpersonal, psychological and social.

These factors can be directly related to food and weight, such as cultural pressures that place great value on obtaining “the perfect body,” and feelings of low self-esteem that may or may not tie into these. Equally, eating disorders can be associated with seemingly unrelated factors such as depression, anxiety, loneliness, introversion and a history of abuse.

Food can be seen as a way in which painful emotions and experiences that might otherwise feel overwhelming can be controlled and dealt with – a coping mechanism. Despite potentially providing a feeling of control, however, eating disorders can severely damage a person’s physical and emotional health.

In terms of physical health, obesity caused by binge-eating disorder can increase the risk of diabetes, hypertension,heart disease and some forms of cancer. Likewise, anorexia can lead to anemia, kidney problems, bone loss and heart problems, such as arrhythmias or heart failure.

Why are eating disorders less recognized in older adults?

While the dangers of eating disorders are well documented, their effect on older adults is not. But why is it that this is the case? MNT asked a number of experts, and one of the overriding responses was a general misconception that eating disorders are disorders of youth.

Empty fridge.
Older people may have difficulty buying or obtaining groceries, but missing food could also be a sign of an eating disorder.

“People fail to recognize that eating disorders can strike people of any age,” said Prof. Bulik, the founding director of the University of North Carolina Center of Excellence for Eating Disorders. “They think that people magically grow out of eating disorders when they leave adolescence. Nothing could be farther from the truth.”

Although the majority of literature and research on eating disorders focuses on younger people – females in particular – and while many eating disorder cases may feature young people, there is plenty of evidence to demonstrate that these diseases are not exclusive to those under 30.

Rather than growing out of eating disorders, many people with these diseases continue to live with their condition from adolescence all the way into late adulthood.

Laurie Cooper, site director at the Renfrew Center in Nashville, TN, told MNT that an erroneous assumption that older adults are not affected by eating disorders has an adverse effect on diagnosis:

“Rather, many family members or helping professionals may attribute weight loss, malnutrition or unexplained symptoms such as vomiting or diarrhea to a ‘normal’ aging process or some other medical condition, rather than amental health disorder.”

In addition, Cooper explained that many individuals who have recovered from eating disorders can experience relapses. Due to their age and status of being in “recovery,” any signs of relapse can be interpreted differently to how they may have been interpreted when the individual was younger.

Unfortunately, some of the symptoms of eating disorders are similar to those associated with the aging process. Older adults may require medication that causes nausea, or they may have functional problems that impair their ability to obtain groceries or plan an adequate diet.

However, even when older adults are living with assistance, eating disorders can still manifest and remain undiagnosed. Prof. Bulik explained:

“We have seen cases of laxative abuse in assisted care facilities, where they often hand laxatives out like candy, but the patients clearly had eating disorders and were using laxatives to purge. We have seen cases of anorexia motivated by beliefs that caloric restriction will extend life.”

The erroneous assumption of eating disorders being exclusive to the young represents one of several unique problems that older adults have to cope with in their fight with these diseases. Help is nearly always required for treating eating disorders, and the first step toward treatment is diagnosis.

A series of unique problems

Age plays an important role in how people cope with disease, both physically and mentally, and this is precisely the case when it comes to eating disorders. As specified earlier, eating disorders can lead to various other serious health problems, and as age increases so do the risks these entail.

“One of the main concerns is that eating disorders take a tremendous toll on just about every bodily system,” explained Prof. Bulik. “In old age, these body systems are less resilient to begin with, just because of the aging process, so eating disorders can erode them more quickly and more seriously.”

Conditions that are more common among older people, such as cardiac problems, gastrointestinal problems,osteoporosis and obesity, can all be exacerbated and complicated further by the presence of an eating disorder.

The combination of older bodies becoming more vulnerable and the underdiagnosis of eating disorders can also make older adults less likely to seek help for these conditions. Even if an individual knows they have a problem, this combination could be enough to put people off seeking help.

Sad unhappy older person.
Many unique and often irreversible life changes occur among the elderly, such as the death of a spouse.

Prof. Bulik told MNT that dismissive comments from physicians – telling patients that they should have “grown out of” eating disorders or that they are “too old” for them – can be a real disincentive to pursue treatment. “Those sorts of comments just lead people to go back into the shadows and not reach out for the treatment they deserve.”

Cooper also suggested that older people could have less support and motivation provided by others to go and seek treatment. “Some individuals may have fewer future goal-related motives for recovery as they see themselves in an end-of-life phase, already anticipating poor health or death.”

Whereas young people may look forward and see a bright future to be had after overcoming an eating disorder, older people may accept these diseases as just another symptom of getting older.

A final unique and inescapable problem comes from the fact that eating disorders are often related to an individual having to cope with stressful life events and needing a way to take control back at a time when they may feel as though they have none at all.

As people age, the chances of them experiencing such an event – the death of a loved one, retirement, increasing loss of independence – increase. “Coping with these mood changing, stressful life events may leave the elderly finding that their current coping skills are not adequate for their present life circumstances,” said Cooper.

Each of these factors represents a challenge posed by eating disorders that are far less likely to be experienced by the young and otherwise healthy individuals who are traditionally associated with these serious diseases.

What is being done?

This week marks National Eating Disorders Awareness Week. One thing that is apparent is how great the need is for awareness to be raised about eating disorders – particularly among smaller sociodemographic groups who are not traditionally associated with eating disorders.

To this end, the NEDA are collaborating with the feminist activist and editor of Everyday Feminism, Melissa A. Fabello, on the Marginalized Voices Project.

“Our goal is to create a collection of stories that tells the whole truth – by spanning the entire spectrum, highlighting stories from people of marginalized identities and that challenge misconceptions – so that we can present the world with what the reality of most eating disorders look like,” the NEDA state.

Stories have been collected specifically focusing on underrepresented experiences and communities with the aim of creating a platform for people to share what it is like having and recovering from an eating disorder.

The project will be launched in the near future, and it is projects like this that are likely to have the biggest impact on the treatment of eating disorders. Raising awareness will hopefully lead to more people seeking treatment and improved rates of diagnosis.

This year’s awareness week theme is “I had no idea,” specifically addressing the need to acknowledge the diverse experiences of people who are affected by eating disorders. “Too often,” say the NEDA, “signs and symptoms are overlooked as insignificant behaviors when in fact many of these are early warning signs of eating disorders.”

Anyone can get involved with these efforts. NEDA suggest that educating yourself and others about eating disorders, debunking myths and spreading the facts are great ways to raise awareness of these diseases in older people. There are also a number of charities that focus on providing information, research and treatment for these diseases.

“The triggers may differ in late life,” said Prof. Bulik, “but the disorders can still take hold.” In order to improve the lives of thousands of people, this message needs to be heard loud and clear.

 


Nurture, not nature, could be a larger issue when dealing with the obesity epidemic

Some scientists say that when mothers eat poorly during pregnancy, they pass along traits to their children that make them more likely to have poor diets and have related health problems.

But a new study in mice by researchers in the Virginia Tech College of Agriculture and Life Sciences and the Edward Via College of Osteopathic Medicine has shown that the environment in which a child lives may be an equal if not stronger force in determining obesity than their mother’s diet.

In other words, nurture, not nature, could be a larger issue when dealing with the obesity epidemic.

The researchers found that having too many food choices increases the obesity problem. In fact, researchers found that having a choice of a high-fat and low-fat diet does not help — offspring in this situation tended to eat even more. Their findings were recently released in the journal Endocrinology.

“We like variety,” said Deborah Good, an author of the paper and an associate professor of human nutrition, foods, and exercise at Virginia Tech. “But when there is a choice, we eat more than when there is not any variety.”

Though the study was done using mice, it can help inform researchers of how human’s natural environment can affect food choices and ultimately a person’s weight. In a country where one-third of adults and 17 percent of children are obese, understanding the root causes of the problem is imperative.

It is the first study of its kind to look at the issue in terms of mimicking a real world environment in which people have the choice between eating fattening foods or healthy low-fat ones. Previous mice studies investigating the role of a mother’s diet in offspring obesity have limited the offspring’s food choice to only high-fat or low-fat diets, but anyone who has walked past the candy aisle to get to the produce section can tell you that is not an accurate representation of life in America. We are constantly faced with making choices and that’s not necessarily a good thing when it comes to obesity.

“We have found that environmental factors are just as important if not more so than a mother’s diet when it comes obesity,” said George Davis, professor in both the Department of Human Nutrition, Foods, and Exercise and the Department of Agricultural and Applied Economics at Virginia Tech.

Renee Prater, the associate dean for curriculum, assessment and medical education at the Edward Via College of Osteopathic Medicine, was also an author.

In this study, the team had two sets of mothers – those given a high-fat diet, and those given a low-fat diet. The offspring were then given a diet that was high fat, low fat, or one in which they had a choice of foods.

The offspring that had a choice of high- or low-fat foods had an increase in body weight, body fat, and glucose levels. Those on a low fat diet showed no such negative impacts. They did, however, have a higher energy expenditure compared to those on low- or high-fat diets. Essentially, the mice burned more energy as they wandered around and evaluated which food they were going to eat.

But having a choice of either a high-fat or low-fat diet can lead to overeating, the experiment found. It is not unlike if someone had the choice of healthy and fatty foods in a grocery store – they may pick both, which leads to a higher daily fat intake.

Though the study was done on mice, the researchers believe the results are telling and could apply to humans. The authors hint that if low-fat foods are more readily available, or priced competitively with high-fat and unhealthy foods, even babies born to overweight mothers could counter their prenatal environment and avoid being overweight themselves.

Prater said that this study is central to the philosophies of osteopathic medicine, which promote wellness and preventive care in medicine.

“This helps to show that if you make good choices, you can overcome some of your natural tendencies and be healthier in the long-run,” she said.

 

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