TheWebCHEMIST.....Common Diseases
ASPIRIN AND ITS SIDE EFFECT.....PLUS AND MINUS POINTS
CROHAN'S DISEASE
QUESTIONS & ANSWERS ABOUT CROHN'S DISEASE
What is Crohn's disease?
Crohn's disease is a serious inflammatory disease of the gastrointestinal (GI) tract. It predominates in the intestine (ileum) and the large intestine (colon), but may occur in any section of the GI tract. Crohn's disease usually causes diarrhea, crampy abdominal pain, often fever, and at times rectal bleeding. Loss of appetite and subsequent weight loss also may occur. Symptoms may range from mild to severe, but in general people with Crohn's disease can lead active and productive lives.
Crohn's disease is chronic. We don't know its cause. Medication currently available decreases inflammation and usually controls the symptoms, but does not provide a cure. Because Crohn's disease behaves similarly to ulcerative colitis, from which it may be difficult to differentiate, the two disorders are grouped together as inflammatory bowel disease (IBD). Unlike Crohn's disease, in which all layers of the intestine are involved, and in which there can be normal healthy bowel in between patches of diseased bowel, ulcerative colitis affects only the innermost lining (mucosa) of the colon in a continuous manner. Depending on where the involvement occurs, Crohn's disease may be referred to as Ileitis, regional enteritis, or colitis, etc. To lessen the confusion, the term Crohn's disease can be used to identify the disease wherever it occurs in the body (ileum, colon, rectum, anus, stomach, duodenum, etc.). It is referred to as Crohn's disease because Burrill B. Crohn was the first name in a three-author landmark paper published in 1932, which described the disease.
How common is inflammatory bowel disease (IBD)?
It is estimated that there may be up to 1,000,000 Americans with IBD. Males and females appear to be affected equally. While Crohn's disease afflicts people of all ages, it is primarily a disease of the young. Most cases are diagnosed before age 30, but the disease can occur in the sixth, seventh, and later decades.
Is Crohn's disease inherited?
We know that Crohn's disease tends to run in families. Studies have shown that about 20 to 25 percent of patients may have a close relative with either Crohn's or ulcerative colitis. There does not seem to be any clear-cut pattern to this familial clustering. Research actively continues in an attempt to establish a link to specific genes governing its transmission. At this time, there is no way to predict which, if any, family members will develop Crohn's disease.
What are the symptoms of Crohn's disease?
In Crohn's disease, abdominal pain and diarrhea are often the earliest signs. The pain is primarily at or below the navel in the abdomen. These symptoms follow a meal. Loss of appetite and weight, joint pains, and fever are common early signs of Crohn's disease can include sores in the anal area, including skin tags mimicking hemorrhoids, fissures (cracks), fistulas (abnormal openings connecting the bowel to the skin surface near the anus), and abscesses.
How is Crohn's disease diagnosed?
The diagnosis is suggested by the history (signs and symptoms). Additional testing to help make the diagnosis may include barium x-rays of the upper and lower GI tract, flexible sigmoidoscopy, and sometimes colonoscopy. (The last two tests permit a direct examination of the colon with a lighted tube inserted through the anus. During these tests, biopsies may be obtained to help make a diagnosis.) Laboratory tests are so helpful and include evaluation of the blood and stool.
Because Crohn's disease often mimics other conditions and symptoms may vary widely, the correct diagnosis of Crohn's disease may take some time.
What medications are used to treat this disease?
Because no medical cure for Crohn's disease exists, the goals of medical treatment are to suppress the inflammatory response, permit healing of tissue, and relieve the symptoms of fever, diarrhea, and abdominal pain.
Several groups of drugs form the mainstay of therapy for Crohn's disease today. They are:
1. Aminosalicylates: aspirin-like drugs, which include sulfasalazine and mesalamine, given both orally and rectally.
2. Corticosteroids: prednisone and methylprednisolone, available orally and rectally.
3. Immune modifiers: azathioprine, 6MP, methotrexate.
4. Antibiotics: metronidazole, ampicillin, ciprofloxacin, and others.
What is the role of surgery in Crohn's disease?
Surgery becomes necessary in Crohn's disease when medication can no longer control the symptoms, or when there is an intestinal obstruction or other complication. In most cases, the diseased segment of bowel is removed and the two ends of healthy bowel are joined together. This is called resection and anastamosis. While this surgery may allow many symptom-free years, it is not considered a cure for Crohn's disease because the disease frequently recurs at or near the site of anastomosis.
An ileostomy may also be required when surgery is performed for Crohn's disease of the colon, if the rectum is diseased and cannot be utilized for an anastomosis.
Is nutrition important in Crohn's disease?
Good nutrition is essential in any chronic disease but especially in this illness, which is characterized by reduced appetite, poor absorption, and diarrhea, all of which rob the body of fluids, nutrients, vitamins, and minerals. Restoration and maintenance of proper nutrition is a vital part of the medical management of Crohn's.
While foods appear to play no role in causing the disease, soft, bland foods may cause less discomfort than spicy or high-fiber foods when the disease is active. Except for restricting milk in lactose intolerant patients, most gastroenterologists try to be flexible in planning the diets of their Crohn's patients.
Can emotional stress trigger attacks of Crohn's disease?
Because body and mind are so closely interrelated, emotional stress can influence the course of Crohn's disease, or any other illness. Although acute emotional problems occasionally precede the onset or recurrence of Crohn's, this sequence does not imply cause and effect.
It is much more, likely that emotional distress sometimes felt by people with Crohn's is a reaction to the painful and embarrassing symptoms caused by the disease itself. Persons with Crohn's should receive understanding and emotional support from their families and from their physicians. Some patients are helped considerably by a therapist knowledgeable about inflammatory bowel disease or about chronic illness in general. Through CCFA, local support groups exist to help patients and their families cope with IBD.
Is it possible to lead a normal life with Crohn's disease?
While it is a serious chronic disease, Crohn's disease is not considered a fatal illness. Most people with the illness continue to lead useful and productive lives, even though they may be hospitalized from time to time, and may need to take medications. In between exacerbations of disease, most people feel well and are relatively free of symptoms.
Even though no medical cure for this disease exists at this time, research and educational programs funded by CCFA have already improved the health and quality of life of people with Crohn's disease. Through CCFA's continuing research efforts, much more will be learned and a cure will be found.
What causes Crohn's disease?
Researchers do not know what causes this disease. They do not believe it is caused by emotional stress or by food, or that it is transmitted directly from person to person.
Research has shown that in IBD the body's defenses are operating against some substances in the body, perhaps in the digestive tract, which they recognize as foreign. These foreign substances (antigens) may themselves cause the inflammation, or may stimulate the body's defenses to produce an inflammation that continues without control.
A major thrust of CCFA-sponsored research has been carried out in the fields of immunology, the study of the body's immune defense system, and microbiology, the study of microscopic organisms with the power to cause disease. Many scientists now believe that the interaction of an outside agent (such as a virus or bacterium) with the body's immune system may trigger the disease, or that such an agent may cause damage to the intestinal wall, initiating or accelerating the disease process.
The Crohn's & Colitis Foundation of America, Inc. (CCFA), is the only private national organization dedicated to finding a cure for the inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Funding from CCFA is in part responsible for exciting breakthroughs in the study of these diseases.
Research is currently underway to identify the genes associated with these diseases and to continue the understanding of how the immune system is activated to begin and perpetuate the disease process.
Local chapters of CCFA are actively involved in professional and patient education and support. For more information about CCFA:
Askari A. Kazmi
Consultant
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Do You Know Your Cholesterol Numbers?
Experts Agree That More Aggressive Screening May Lower Heart Disease
By Hong Mautz
WebMD Health
Many studies show that people with high cholesterol levels should be treated with cholesterol-lowering drugs, but aren't. And guidelines published last year have lowered the mark even further, categorizing more people as having high cholesterol levels making them candidates for cholesterol-lowering treatments.
According to the American Heart Association (AHA), more than 100 million adults in the United States have blood cholesterol levels considered borderline high (over 200), and close to 40 million adults have levels considered high (over 240). High cholesterol levels are strongly linked to an increased risk for heart disease, which is the leading killer of both men and women in the United States, accounting for about 500,000 deaths each year.
National Cholesterol Education Program (NCEP) guidelines, published in 2001 focus on preventing heart disease by reducing low-density lipoprotein cholesterol (LDL, the "bad" cholesterol) levels with lifestyle changes and medication. The old guidelines, issued in 1993, focused on a person's total cholesterol level, including both LDL and high-density lipoprotein cholesterol (HDL, the "good" cholesterol).
"New evidence shows without doubt that lowering the low-density lipoprotein cholesterol is beneficial," says Scott Grundy, MD, chairman of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults that developed the guidelines. "These guidelines will provide confidence for physicians to treat their patients appropriately."
20 and Older
The guidelines say that everyone age 20 and older should have blood tests to measure their lipoprotein profile every 5 years. A lipoprotein profile tells you your LDL and HDL cholesterol levels as well as your triglyceride (another fat in the blood) level.
If your LDL cholesterol level is 130 or higher, you should start taking cholesterol-lowering drugs and make lifestyle changes -- like having less saturated fat and cholesterol in your diet, losing weight, and exercising more -- to reach an LDL level of less than 100.
Michael Lauer, MD, a cardiologist at the Cleveland Clinic Foundation, in Cleveland, Ohio says the guidelines reflect a better understanding of how managing high cholesterol prevents heart disease.
"There is a need to be even more aggressive and vigilant about treating cholesterol disorders in the population," he says.
Lauer says that people who should be taking cholesterol-lowering drugs usually aren't. "The problem we have right now is that we have treatment that works and [preventive methods that work] but are not being used," he says.
At-Risk Patients
Using these guidelines, Ronald Krauss, MD, chairman of the AHA Council on Nutrition, Physical Activity and Metabolism, says that doctors now have a better way to identify people at risk for heart disease and give them the best care.
"Physicians now have new tools for sharpening up their assessment of their patients' risk for heart disease or for recurring heart disease," says Krauss. "They will have very specific recommendations for using both diet and medication where needed to achieve targets that are connected to their patients' risk."
One area of risk that deserves emphasis, he says, is the distribution of body fat, like the like the "apple" body type (fat around the midsection) which has been linked to a higher risk of heart disease. People with an apple-shaped distribution of fat may need more aggressive treatment of borderline cholesterol to lower their risk.
Another condition called the "metabolic syndrome" is another major risk for heart disease. The metabolic syndrome is a combination of the apple body type, high blood pressure, a high triglyceride level, low HDL cholesterol, and high blood sugar.
"Insulin resistance [the inability to use the hormone insulin] is responsible for metabolic syndrome, which has become more significant over the years since more Americans are overweight," says Krauss. "The key treatment for this is to reduce weight and increase physical activity. It deserves to be aggressively treated." Insulin resistance can lead to diabetes.
Krauss describes the typical person with borderline metabolic syndrome as a man with a waistline of 40 inches, a triglyceride level of 180, and an HDL level of 40. "That person might have sailed through the previous guidelines," says Krauss. "But now, we will catch that person and provide the lipid management he needs."
What's more, the guidelines now say that people with diabetes should be treated as if they have heart disease. The old guidelines considered diabetes merely a risk for developing heart disease.
Original Publication Date: May 2001
Reviewed by Charlotte E. Grayson, MD, WebMD, February 2002.
Who Should Take Cholesterol-Lowering Drugs, and Why?
The Answers May Surprise You
By Michael D. Howell, MD
Beth Israel Deaconess Medical Center, Harvard Medical School
A major study has found that one cholesterol-lowering drug -- a member of the popular class of drugs called statins -- may save tens of thousands of lives a year by dramatically reducing the number of heart attacks and strokes that would otherwise strike those who take this medication, and perhaps those who take other statins.
The benefits seem to apply to men and women, seniors, people with diabetes, and even to many people who don't have high cholesterol in the first place -- but who may be at higher-than-normal risk for heart disease for other reasons.
Researchers at Oxford University began the trial, called the Heart Protection Study, in 1994 using the drug Zocor. Their aim was to see if statins could help other people in addition to those who now fit the guidelines that describe who should take them.
Their results, presented at the American Heart Association's annual meeting in 2001, seem likely to eventually change the standard of care for millions of people worldwide who are at high risk for heart disease but who don't meet usual guidelines that normally determine who should go on cholesterol-lowering medications. For these patients, they found that Zocor reduced the risk of heart attacks and strokes by about one third, and of death by more than 10%.
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Why are these results so important?
Because heart disease and stroke kill so many people, even small improvements in treatment may save many lives. On average, one American:
Has a heart attack every 29 seconds, and one dies as a result of a heart attack every minute
Has a stroke every 53 seconds, and one dies as a result of a heart attack every 3.3 minutes
Ailments that affect the blood vessels, including atherosclerosis ("hardening of the arteries"), cause more than 40% of all deaths in the United States.
Exactly who does this study apply to?
People between 40 and 80 years old who have heart disease, or who are at high risk for it. That includes:
Anyone who has diabetes
Anyone who has had a stroke or a ministroke (also called a transient ischemic attack, or TIA)
Anyone who has been diagnosed as having blockage in an artery of the leg or neck
This includes many people whose cholesterol level is normal. No earlier trials had studied the effect of statins on this group of people.
What are the major results of this study?
In patients at high risk for heart disease -- no matter what their cholesterol levels -- Zocor reduced:
The risk of heart attacks and of strokes by over 30%
The need for arterial surgery and amputations
The risk of death from any cause by 12%
These results hold for a very broad range of patients:
Women and men
People over 70, as well as younger people
People with all levels of cholesterol -- even those with levels usually considered to be normal or even low
Is this a "good" study that I should take seriously?
Definitely. The investigators studied more than 20,000 people -- far and away the largest trial of this kind. The design -- a randomized, placebo-controlled trial -- is the strongest kind of trial, and the results are statistically compelling.
How many people could this benefit?
If you treated 1,000 high-risk people with Zocor for five years, the Heart Protection Study data suggest that among that group you would prevent a heart attack, stroke, or other major vascular event in
100 people who had previously had a heart attack
70 people who had previously had a stroke
70 people with diseased leg or neck arteries
70 people with diabetes
To save one life, you would only need to treat 59 high-risk people for five years. If you treated 10 million people, roughly 34,000 deaths would be prevented every year.
I heard that a cholesterol drug was recently pulled off the market. Should I be worried about it, or Zocor?
In August of 2001, Bayer voluntarily took Baycol off the market because of concerns that it might cause rapid muscle breakdown in some people. This muscle breakdown, called rhabdomyolysis, can sometimes be fatal. In fact, in the U.S., there were 31 rhabdomyolysis-related deaths in four years in people taking the drug.
Zocor is part of the same drug class ("statins") as Baycol. However, Zocor seems to have much less risk of rhabdomyolysis. In the Heart Protection Study, 10,269 people took Zocor. No one who took Zocor died from rhabdomyolysis, and there were only nine cases of it at all. In the 10,267 patients who took a placebo -- a dummy pill -- instead of Zocor, there were five cases of rhabdomyolysis. (In other words, in such a large group of people a few can be expected to develop this problem on their own.)
If you're taking a statin drug, you should call your doctor if you have muscle weakness or pain, since that's often the first sign of rhabdomyolysis. In some patients, doctors will also check occasional blood tests to monitor for this and other problems.
This study looked at Zocor. Are other statins equally safe and effective?
There have been a great many cholesterol-drug trials. Results suggest that other statins, such as Lescol, Lipitor, Mevacor, and Pravachol, will have protective effects similar to those of Zocor, but we can't know for sure without further research. The problems that arose with Baycol, though, show that the safety of each drug is very individual. It's widely believed, however, that the other statin drugs on the market are safe.
The study also found that a daily antioxidant pill failed to produce heart-healthy benefits. Should I stop taking my daily vitamins for my heart?
In the same group of patients, the Heart Protection Study found that taking vitamin C, vitamin E, and beta-carotene offered no protection from heart attacks, strokes, or death. That makes it hard for doctors to recommend them. The bright spot is that these vitamins appeared to be very safe -- contradicting smaller studies that suggested they might increase the risk of some kinds of cancer and of certain strokes.
The decision whether to keep taking these vitamins for the heart is, probably, mostly a financial one. At the doses studied, there's no data providing evidence of a medical benefit in preventing heart disease, but the only risk seems to be to your wallet.
What should I do now?
If you're over the age of 40, not taking a statin, and you have ever had:
Heart problems
A stroke
A ministroke
Blockage in the arteries of the legs or neck
Diabetes
you may want to ask your doctor if this study applies to you. You should keep in mind that there may be other reasons your doctor will choose not to prescribe a statin, but it's certainly reasonable to ask.
Originally reviewed by:
Beth Israel Deaconess Medical Center. Reviewed for medical accuracy by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. BIDMC does not endorse any products or services advertised on this Web site.
Original Publication Date: November 2001
Reviewed by Charlotte E. Grayson, MD, WebMD, February 2002.
Unscrambling the News About Eggs
American Heart Association Advice: Eggs Have a Place in a Healthy Diet
By Jeanie Davis
WebMD Medical News
The simple egg isn't the hard-boiled nemesis it used to be. Bedeviled by years of bad press, the egg's reputation has finally turned for the better. Amazing it didn't crack under the pressure.
"Eggs are back," says Donald J. McNamara, PhD, executive director of the Egg Nutrition Center in Washington, D.C. "They're not the bad guys we used to think they were."
Thirty years ago, eggs were virtually banned from the American diet because of their cholesterol content.
Cholesterol does play a role in heart disease -- "but today, we know that the cholesterol in eggs plays a very minor role," McNamara tells WebMD. "It's saturated fat in the diet that has the biggest impact" -- that's fast food, deep-fried foods, fatty meats, high-fat dairy products, junk food.
So, What Should You Eat?
"We want people to eat more vegetables and fruit, more whole grains, more fish, more low-fat dairy products, and to reduce the saturated and trans-fat foods," says Barbara Howard, PhD, chairwoman of the American Heart Association's Nutrition Committee. Trans-fats are found in margarine and many other fried and baked products.
"Eggs can fit into a healthy, balanced diet," she tells WebMD.
In fact, a Harvard study published in The Journal of the American Medical Association two years ago looked at the egg/coronary heart disease issue. Researchers found that consumption of up to one egg per day did not have a significant impact on risk for heart disease or stroke.
The AHA's advice: We should eat 300 mg or less of cholesterol in a day's time. An egg has 200 mg of cholesterol.
"Think of your diet as a budget, like your monthly checkbook allowance," Howard tells WebMD. "If you eat an egg during the day, make sure you eat fewer of the other foods that have cholesterol in them, like butter, high-fat dairy products, and meats."
A Hidden Benefit
More egg-citing news: Those yellow egg yolks contain lutein, a caroteinoid that may protect against the development of hardening of the arteries (atherosclerosis) which leads to heart disease and other disorders, according to a recent study published in Circulation: Journal of the American Heart Association. Lutein has also been shown to protect against age-related macular degeneration (a vision condition that can cause blindness) and to improve long-term memory function. Lutein is also found in deep yellow-colored fruits and vegetables.
The emphasis is on eating a balanced diet -- not on eating an egg a day, she says.
Howard adds: "For seniors, it's a very easy product to prepare, easy to chew and digest, and there are not a lot of calories."
Eggs are a high-quality source of protein, 13 essential vitamins and minerals, significant amounts of vitamin B-12, vitamin D, and folate. Eggs also contain choline, an essential nutrient involved in brain function. Choline is transferred to the fetus and newborn, and research indicates it is essential for development of brain centers and long-term memory centers, says McNamara.
Thankfully, salmonella -- a cramping, diarrheal type of infection -- is no longer a big problem in the egg world, McNamara says. "Our industry has incorporated a lot of quality assurance programs over the last 10 years. Salmonella has gone down 48% in the last six years."
Chickens are being vaccinated against salmonella, which has shown to be effective. Also, many eggs are pasteurized before they hit the market. McNamara quotes CDC figures: One egg in 20,000 is internally contaminated. "If you eat a raw egg every single day for 54 years, you wouldn't run into one egg with salmonella."
Only raw and undercooked eggs present the biggest salmonella risk, he says. "The FDA estimates that in food service, maybe as much as 20% are slightly undercooked, so they might be a risk."
But come Easter Sunday, those boiled eggs -- as pretty as they are -- should spend most of their time in the fridge, McNamara advises. "You have to treat it like any perishable product. If you leave it out for two hours, you run the risk that it's contaminated."
Originally published March 29, 2002.
Reviewed by Charlotte E. Grayson, MD, WebMD, April 2002.
Facts About Cholesterol
WebMD Medical Staff
Is the cholesterol in egg yolks the "good" or "bad" kind? Can you "burn" cholesterol by exercising? Which has more cholesterol, a tablespoon of butter or a cup of peanut butter?
Most people know that fat is bad for them, but two-thirds of Americans are confused about how cholesterol differs from fats. The fat issue is actually the most clearly defined topic in nutrition. Yes, most Americans should cut the fat. They need to do it now and for the rest of their lives, for the sake of their hearts, health and waistlines.
The Facts about Cholesterol
Can You Burn Off Cholesterol?
Cholesterol is a type of lipid, just as fats are. However, unlike fat, cholesterol can't be exercised off, sweated out or burned for energy. It is found only in animal products, including meat, chicken, fish, eggs, organ meats and high-fat dairy products.
Is Cholesterol Good or Bad?
Just as homemade oil-and-vinegar dressing separates into a watery pool with a fat-slick topping, so also would fats and cholesterol if they were dumped directly into the blood. To solve this dilemma, the body transports fat and cholesterol by coating them with a water-soluble "bubble" of protein. This protein-fat bubble is called a lipoprotein.
Low-density lipoproteins (LDLs) carry cholesterol to the tissues. This is "bad" cholesterol, since high LDL levels are linked to increased risk for heart disease.
High-density lipoproteins (HDLs) carry excess cholesterol back to the liver, which processes and excretes the cholesterol. HDLs are "good" cholesterol; The more HDL you have, the lower your risk for developing heart disease.
HDLs and LDLs are found only in your blood, not in food.
Test Your Cholesterol
Your risk for heart disease can be assessed with a blood-cholesterol test. In this test, your total-cholesterol reading should approximate the sum of your LDL, HDL and other lipoproteins. If you have 3.5 mg of total cholesterol, or less, for every 1 mg of HDLs, then your cholesterol ratio is ideal. According to guidelines from the National Cholesterol Education Program:
Total cholesterol should remain below 200 mg/dL, unless HDL is high.
LDL should be lower than 130 mg/dL.
HDL should be 40 mg/dl or higher.
However, if you have any risk factors for heart disease, you'll want to get your LDL even lower, less than 100 is optimal
The Fat Primer
The fats that supply calories, float in your blood and accumulate in your thighs and hips are called "triglycerides." They can be saturated or unsaturated, and the unsaturated ones can be either monounsaturated or polyunsaturated. For every ounce of triglycerides you eat, you add 250 calories (or 9 calories per gram -- the weight of a raisin) to your diet. Only saturated fats increase blood levels of cholesterol and heart-disease risk.
Which Ones Are Saturated?
In general, the harder a fat, the more saturated it is. Beef and dairy fats are mostly saturated fats. Liquid oils are usually unsaturated fats, including monounsaturated fats in olive and canola oils and polyunsaturated fats in safflower, corn, soybean and fish oils. Coconut, palm and palm kernel oils are exceptions to the rule; these liquid vegetable oils are highly saturated fats.
Fear of Frying
Eating foods with a lot of saturated fat raises your risk for heart disease; this causes the amount of bad LDLs in your blood to increase while good HDLs decrease. Cut the saturated fat, and your blood-cholesterol levels and your risk for heart disease drop. Your risk for cancer also decreases. A diet with more polyunsaturated fats, rather than saturated fats, lowers total blood-cholesterol levels, but unfortunately also drops HDL levels, so you lose both good and bad cholesterol. Olive oil is another story. This oil lowers total-blood cholesterol and LDL cholesterol without causing HDL levels to drop. By using olive oil, you can decrease your total-cholesterol levels while maintaining your HDL levels, thus decreasing your risk for heart disease. Fish oil also lowers heart-disease risk. Consequently, olive and fish are the oils of choice.
Trans, Schmans
Hydrogenated fats are liquid vegetable oils made creamy when manufacturers convert some of the unsaturated fats into saturated ones through a process called "hydrogenation." This process also rearranges the molecular shape of the remaining unsaturated fats. The resulting shape is an abnormal "trans" shape.
Trans fatty acids constitute up to 60 percent of the fat in processed foods containing hydrogenated fats. TFAs raise blood-cholesterol levels and increase heart-disease risk just like saturated fats. Knowing your fats gives you an edge when it comes to buying and preparing the right foods to eat. And when you steer away from the saturated fat and trans fatty acids, you can live a heart-healthy life. The bottom line is:
Eat less fat, especially saturated fat.
Limit your intake of fatty meats, fatty dairy products and processed foods that contain hydrogenated vegetable oil.
Use olive oil, but in moderation if you're watching your weight.
Fill your plate with fruit, vegetables, whole grains, fish and legumes.
The Power of Lifestyle Changes
By Dean Ornish, MD
for WebMD Health
Heart and blood vessel diseases account for more premature deaths each year than nearly everything else combined. Yet heart disease is preventable and even reversible for most people.
We tend to think of advances in medicine as a new drug, surgical technique, something high-tech and expensive. Yet the choices we make each day -- what we eat, how we respond to stress, how much we exercise, whether we smoke, and our relationships with others -- can make powerful differences in our health and well-being.
You don't have to make such big changes to prevent heart disease as to reverse it. Here's how you can customize a diet and lifestyle program that's just right for you:
Steps To Take
If your total cholesterol level is consistently below 150 mg/dL or your LDL cholesterol is below 95, either you're not eating much fat and cholesterol, or your body is good at getting rid of it. Either way, your risk of heart disease is low.
If it's above these levels, begin cutting back on dietary fat and cholesterol. If that's enough to bring it down, great; if not, then continue cutting back until you reach the desired goals. If you're not interested in making bigger changes in diet and lifestyle, talk with your doctor about whether cholesterol-lowering drugs are right for you. Many, perhaps most people, can avoid these drugs if they make bigger changes in diet and lifestyle than what many doctors recommend.
What you include in your diet is as important as what you exclude. When go from a high-fat, high-cholesterol diet rich in animal protein to a low-fat, whole foods, plant-based diet, you get a double benefit. You reduce your intake of disease-promoting substances and you get at least 1,000 substances that help protect against heart disease, cancer, and other illnesses. These substances are found mainly in fruits, vegetables, grains, beans, and soy products. Folate, in grains and green vegetables, reduces homocysteine levels, which decreases cardiac risk. Three grams per day of flax seed oil or fish oil contain omega-3 fatty acids that may reduce the incidence of sudden cardiac death by more than 50%.
Making Connections
It's not just diet. Studies show that people who feel lonely, depressed, and isolated are much more likely to get sick and die prematurely than those who have feelings of love, connection, and community. People who are lonely and depressed are more likely to smoke, overeat, drink too much, and work too hard as a way of coping, numbing, and distracting themselves. As one patient told me, "I have 20 friends in this package of cigarettes and they're always there for me, and no one else is."
Also, depression and loneliness cause premature death through mechanisms we don't fully understand. One study showed that six months after a heart attack, more than five times as many depressed patients were dead compared with those who weren't depressed. Depression is highly treatable, so it's important to reach out for help.
Stress isn't just what you do -- more important is how you react to what you do. Yoga and meditation can help you react to stress on the job or at home in a healthier way. Even a few minutes a day can make a big difference.
Working It Out
Moderate exercise provides most of the health benefits of more intense exercise. Walking 20-30 minutes a day can reduce risk of premature death by 50%.
Concepts such as "risk factor modification" and "prevention" are considered borrrrrrring by many people. They wonder, "Am I going to live longer, or is it just going to seem longer?"
When you make big changes in diet and lifestyle, you may feel so much better, so quickly, the choices become clearer. Not just to live longer, but also to live better -- for joy of living, not fear of dying. Your brain may get more oxygen, so you may think more clearly and have more energy. Your skin gets more blood, reducing wrinkles and other signs of premature aging. Even sexual organs often receive more blood flow, just as Viagra works.
When you change your diet and lifestyle, blood flow to the heart can improve quickly. If you quit smoking, within five years your risk of having a heart attack falls almost as low as if you had never smoked. Your body has a remarkable capacity to begin healing itself if you give it a chance.
Dean Ornish, MD, is founder and president of the nonprofit Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco.
Askari A. Kazmi
Consultant
What is Crohn's disease?
Crohn's disease is a serious inflammatory disease of the gastrointestinal (GI) tract. It predominates in the intestine (ileum) and the large intestine (colon), but may occur in any section of the GI tract. Crohn's disease usually causes diarrhea, crampy abdominal pain, often fever, and at times rectal bleeding. Loss of appetite and subsequent weight loss also may occur. Symptoms may range from mild to severe, but in general people with Crohn's disease can lead active and productive lives.
Crohn's disease is chronic. We don't know its cause. Medication currently available decreases inflammation and usually controls the symptoms, but does not provide a cure. Because Crohn's disease behaves similarly to ulcerative colitis, from which it may be difficult to differentiate, the two disorders are grouped together as inflammatory bowel disease (IBD). Unlike Crohn's disease, in which all layers of the intestine are involved, and in which there can be normal healthy bowel in between patches of diseased bowel, ulcerative colitis affects only the innermost lining (mucosa) of the colon in a continuous manner. Depending on where the involvement occurs, Crohn's disease may be referred to as Ileitis, regional enteritis, or colitis, etc. To lessen the confusion, the term Crohn's disease can be used to identify the disease wherever it occurs in the body (ileum, colon, rectum, anus, stomach, duodenum, etc.). It is referred to as Crohn's disease because Burrill B. Crohn was the first name in a three-author landmark paper published in 1932, which described the disease.
How common is inflammatory bowel disease (IBD)?
It is estimated that there may be up to 1,000,000 Americans with IBD. Males and females appear to be affected equally. While Crohn's disease afflicts people of all ages, it is primarily a disease of the young. Most cases are diagnosed before age 30, but the disease can occur in the sixth, seventh, and later decades.
Is Crohn's disease inherited?
We know that Crohn's disease tends to run in families. Studies have shown that about 20 to 25 percent of patients may have a close relative with either Crohn's or ulcerative colitis. There does not seem to be any clear-cut pattern to this familial clustering. Research actively continues in an attempt to establish a link to specific genes governing its transmission. At this time, there is no way to predict which, if any, family members will develop Crohn's disease.
What are the symptoms of Crohn's disease?
In Crohn's disease, abdominal pain and diarrhea are often the earliest signs. The pain is primarily at or below the navel in the abdomen. These symptoms follow a meal. Loss of appetite and weight, joint pains, and fever are common early signs of Crohn's disease can include sores in the anal area, including skin tags mimicking hemorrhoids, fissures (cracks), fistulas (abnormal openings connecting the bowel to the skin surface near the anus), and abscesses.
How is Crohn's disease diagnosed?
The diagnosis is suggested by the history (signs and symptoms). Additional testing to help make the diagnosis may include barium x-rays of the upper and lower GI tract, flexible sigmoidoscopy, and sometimes colonoscopy. (The last two tests permit a direct examination of the colon with a lighted tube inserted through the anus. During these tests, biopsies may be obtained to help make a diagnosis.) Laboratory tests are so helpful and include evaluation of the blood and stool.
Because Crohn's disease often mimics other conditions and symptoms may vary widely, the correct diagnosis of Crohn's disease may take some time.
What medications are used to treat this disease?
Because no medical cure for Crohn's disease exists, the goals of medical treatment are to suppress the inflammatory response, permit healing of tissue, and relieve the symptoms of fever, diarrhea, and abdominal pain.
Several groups of drugs form the mainstay of therapy for Crohn's disease today. They are:
1. Aminosalicylates: aspirin-like drugs, which include sulfasalazine and mesalamine, given both orally and rectally.
2. Corticosteroids: prednisone and methylprednisolone, available orally and rectally.
3. Immune modifiers: azathioprine, 6MP, methotrexate.
4. Antibiotics: metronidazole, ampicillin, ciprofloxacin, and others.
What is the role of surgery in Crohn's disease?
Surgery becomes necessary in Crohn's disease when medication can no longer control the symptoms, or when there is an intestinal obstruction or other complication. In most cases, the diseased segment of bowel is removed and the two ends of healthy bowel are joined together. This is called resection and anastamosis. While this surgery may allow many symptom-free years, it is not considered a cure for Crohn's disease because the disease frequently recurs at or near the site of anastomosis.
An ileostomy may also be required when surgery is performed for Crohn's disease of the colon, if the rectum is diseased and cannot be utilized for an anastomosis.
Is nutrition important in Crohn's disease?
Good nutrition is essential in any chronic disease but especially in this illness, which is characterized by reduced appetite, poor absorption, and diarrhea, all of which rob the body of fluids, nutrients, vitamins, and minerals. Restoration and maintenance of proper nutrition is a vital part of the medical management of Crohn's.
While foods appear to play no role in causing the disease, soft, bland foods may cause less discomfort than spicy or high-fiber foods when the disease is active. Except for restricting milk in lactose intolerant patients, most gastroenterologists try to be flexible in planning the diets of their Crohn's patients.
Can emotional stress trigger attacks of Crohn's disease?
Because body and mind are so closely interrelated, emotional stress can influence the course of Crohn's disease, or any other illness. Although acute emotional problems occasionally precede the onset or recurrence of Crohn's, this sequence does not imply cause and effect.
It is much more, likely that emotional distress sometimes felt by people with Crohn's is a reaction to the painful and embarrassing symptoms caused by the disease itself. Persons with Crohn's should receive understanding and emotional support from their families and from their physicians. Some patients are helped considerably by a therapist knowledgeable about inflammatory bowel disease or about chronic illness in general. Through CCFA, local support groups exist to help patients and their families cope with IBD.
Is it possible to lead a normal life with Crohn's disease?
While it is a serious chronic disease, Crohn's disease is not considered a fatal illness. Most people with the illness continue to lead useful and productive lives, even though they may be hospitalized from time to time, and may need to take medications. In between exacerbations of disease, most people feel well and are relatively free of symptoms.
Even though no medical cure for this disease exists at this time, research and educational programs funded by CCFA have already improved the health and quality of life of people with Crohn's disease. Through CCFA's continuing research efforts, much more will be learned and a cure will be found.
What causes Crohn's disease?
Researchers do not know what causes this disease. They do not believe it is caused by emotional stress or by food, or that it is transmitted directly from person to person.
Research has shown that in IBD the body's defenses are operating against some substances in the body, perhaps in the digestive tract, which they recognize as foreign. These foreign substances (antigens) may themselves cause the inflammation, or may stimulate the body's defenses to produce an inflammation that continues without control.
A major thrust of CCFA-sponsored research has been carried out in the fields of immunology, the study of the body's immune defense system, and microbiology, the study of microscopic organisms with the power to cause disease. Many scientists now believe that the interaction of an outside agent (such as a virus or bacterium) with the body's immune system may trigger the disease, or that such an agent may cause damage to the intestinal wall, initiating or accelerating the disease process.
The Crohn's & Colitis Foundation of America, Inc. (CCFA), is the only private national organization dedicated to finding a cure for the inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Funding from CCFA is in part responsible for exciting breakthroughs in the study of these diseases.
Research is currently underway to identify the genes associated with these diseases and to continue the understanding of how the immune system is activated to begin and perpetuate the disease process.
Local chapters of CCFA are actively involved in professional and patient education and support. For more information about CCFA:
Askari A. Kazmi
Consultant
____________________
Do You Know Your Cholesterol Numbers?
Experts Agree That More Aggressive Screening May Lower Heart Disease
By Hong Mautz
WebMD Health
Many studies show that people with high cholesterol levels should be treated with cholesterol-lowering drugs, but aren't. And guidelines published last year have lowered the mark even further, categorizing more people as having high cholesterol levels making them candidates for cholesterol-lowering treatments.
According to the American Heart Association (AHA), more than 100 million adults in the United States have blood cholesterol levels considered borderline high (over 200), and close to 40 million adults have levels considered high (over 240). High cholesterol levels are strongly linked to an increased risk for heart disease, which is the leading killer of both men and women in the United States, accounting for about 500,000 deaths each year.
National Cholesterol Education Program (NCEP) guidelines, published in 2001 focus on preventing heart disease by reducing low-density lipoprotein cholesterol (LDL, the "bad" cholesterol) levels with lifestyle changes and medication. The old guidelines, issued in 1993, focused on a person's total cholesterol level, including both LDL and high-density lipoprotein cholesterol (HDL, the "good" cholesterol).
"New evidence shows without doubt that lowering the low-density lipoprotein cholesterol is beneficial," says Scott Grundy, MD, chairman of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults that developed the guidelines. "These guidelines will provide confidence for physicians to treat their patients appropriately."
20 and Older
The guidelines say that everyone age 20 and older should have blood tests to measure their lipoprotein profile every 5 years. A lipoprotein profile tells you your LDL and HDL cholesterol levels as well as your triglyceride (another fat in the blood) level.
If your LDL cholesterol level is 130 or higher, you should start taking cholesterol-lowering drugs and make lifestyle changes -- like having less saturated fat and cholesterol in your diet, losing weight, and exercising more -- to reach an LDL level of less than 100.
Michael Lauer, MD, a cardiologist at the Cleveland Clinic Foundation, in Cleveland, Ohio says the guidelines reflect a better understanding of how managing high cholesterol prevents heart disease.
"There is a need to be even more aggressive and vigilant about treating cholesterol disorders in the population," he says.
Lauer says that people who should be taking cholesterol-lowering drugs usually aren't. "The problem we have right now is that we have treatment that works and [preventive methods that work] but are not being used," he says.
At-Risk Patients
Using these guidelines, Ronald Krauss, MD, chairman of the AHA Council on Nutrition, Physical Activity and Metabolism, says that doctors now have a better way to identify people at risk for heart disease and give them the best care.
"Physicians now have new tools for sharpening up their assessment of their patients' risk for heart disease or for recurring heart disease," says Krauss. "They will have very specific recommendations for using both diet and medication where needed to achieve targets that are connected to their patients' risk."
One area of risk that deserves emphasis, he says, is the distribution of body fat, like the like the "apple" body type (fat around the midsection) which has been linked to a higher risk of heart disease. People with an apple-shaped distribution of fat may need more aggressive treatment of borderline cholesterol to lower their risk.
Another condition called the "metabolic syndrome" is another major risk for heart disease. The metabolic syndrome is a combination of the apple body type, high blood pressure, a high triglyceride level, low HDL cholesterol, and high blood sugar.
"Insulin resistance [the inability to use the hormone insulin] is responsible for metabolic syndrome, which has become more significant over the years since more Americans are overweight," says Krauss. "The key treatment for this is to reduce weight and increase physical activity. It deserves to be aggressively treated." Insulin resistance can lead to diabetes.
Krauss describes the typical person with borderline metabolic syndrome as a man with a waistline of 40 inches, a triglyceride level of 180, and an HDL level of 40. "That person might have sailed through the previous guidelines," says Krauss. "But now, we will catch that person and provide the lipid management he needs."
What's more, the guidelines now say that people with diabetes should be treated as if they have heart disease. The old guidelines considered diabetes merely a risk for developing heart disease.
Original Publication Date: May 2001
Reviewed by Charlotte E. Grayson, MD, WebMD, February 2002.
Who Should Take Cholesterol-Lowering Drugs, and Why?
The Answers May Surprise You
By Michael D. Howell, MD
Beth Israel Deaconess Medical Center, Harvard Medical School
A major study has found that one cholesterol-lowering drug -- a member of the popular class of drugs called statins -- may save tens of thousands of lives a year by dramatically reducing the number of heart attacks and strokes that would otherwise strike those who take this medication, and perhaps those who take other statins.
The benefits seem to apply to men and women, seniors, people with diabetes, and even to many people who don't have high cholesterol in the first place -- but who may be at higher-than-normal risk for heart disease for other reasons.
Researchers at Oxford University began the trial, called the Heart Protection Study, in 1994 using the drug Zocor. Their aim was to see if statins could help other people in addition to those who now fit the guidelines that describe who should take them.
Their results, presented at the American Heart Association's annual meeting in 2001, seem likely to eventually change the standard of care for millions of people worldwide who are at high risk for heart disease but who don't meet usual guidelines that normally determine who should go on cholesterol-lowering medications. For these patients, they found that Zocor reduced the risk of heart attacks and strokes by about one third, and of death by more than 10%.
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Why are these results so important?
Because heart disease and stroke kill so many people, even small improvements in treatment may save many lives. On average, one American:
Has a heart attack every 29 seconds, and one dies as a result of a heart attack every minute
Has a stroke every 53 seconds, and one dies as a result of a heart attack every 3.3 minutes
Ailments that affect the blood vessels, including atherosclerosis ("hardening of the arteries"), cause more than 40% of all deaths in the United States.
Exactly who does this study apply to?
People between 40 and 80 years old who have heart disease, or who are at high risk for it. That includes:
Anyone who has diabetes
Anyone who has had a stroke or a ministroke (also called a transient ischemic attack, or TIA)
Anyone who has been diagnosed as having blockage in an artery of the leg or neck
This includes many people whose cholesterol level is normal. No earlier trials had studied the effect of statins on this group of people.
What are the major results of this study?
In patients at high risk for heart disease -- no matter what their cholesterol levels -- Zocor reduced:
The risk of heart attacks and of strokes by over 30%
The need for arterial surgery and amputations
The risk of death from any cause by 12%
These results hold for a very broad range of patients:
Women and men
People over 70, as well as younger people
People with all levels of cholesterol -- even those with levels usually considered to be normal or even low
Is this a "good" study that I should take seriously?
Definitely. The investigators studied more than 20,000 people -- far and away the largest trial of this kind. The design -- a randomized, placebo-controlled trial -- is the strongest kind of trial, and the results are statistically compelling.
How many people could this benefit?
If you treated 1,000 high-risk people with Zocor for five years, the Heart Protection Study data suggest that among that group you would prevent a heart attack, stroke, or other major vascular event in
100 people who had previously had a heart attack
70 people who had previously had a stroke
70 people with diseased leg or neck arteries
70 people with diabetes
To save one life, you would only need to treat 59 high-risk people for five years. If you treated 10 million people, roughly 34,000 deaths would be prevented every year.
I heard that a cholesterol drug was recently pulled off the market. Should I be worried about it, or Zocor?
In August of 2001, Bayer voluntarily took Baycol off the market because of concerns that it might cause rapid muscle breakdown in some people. This muscle breakdown, called rhabdomyolysis, can sometimes be fatal. In fact, in the U.S., there were 31 rhabdomyolysis-related deaths in four years in people taking the drug.
Zocor is part of the same drug class ("statins") as Baycol. However, Zocor seems to have much less risk of rhabdomyolysis. In the Heart Protection Study, 10,269 people took Zocor. No one who took Zocor died from rhabdomyolysis, and there were only nine cases of it at all. In the 10,267 patients who took a placebo -- a dummy pill -- instead of Zocor, there were five cases of rhabdomyolysis. (In other words, in such a large group of people a few can be expected to develop this problem on their own.)
If you're taking a statin drug, you should call your doctor if you have muscle weakness or pain, since that's often the first sign of rhabdomyolysis. In some patients, doctors will also check occasional blood tests to monitor for this and other problems.
This study looked at Zocor. Are other statins equally safe and effective?
There have been a great many cholesterol-drug trials. Results suggest that other statins, such as Lescol, Lipitor, Mevacor, and Pravachol, will have protective effects similar to those of Zocor, but we can't know for sure without further research. The problems that arose with Baycol, though, show that the safety of each drug is very individual. It's widely believed, however, that the other statin drugs on the market are safe.
The study also found that a daily antioxidant pill failed to produce heart-healthy benefits. Should I stop taking my daily vitamins for my heart?
In the same group of patients, the Heart Protection Study found that taking vitamin C, vitamin E, and beta-carotene offered no protection from heart attacks, strokes, or death. That makes it hard for doctors to recommend them. The bright spot is that these vitamins appeared to be very safe -- contradicting smaller studies that suggested they might increase the risk of some kinds of cancer and of certain strokes.
The decision whether to keep taking these vitamins for the heart is, probably, mostly a financial one. At the doses studied, there's no data providing evidence of a medical benefit in preventing heart disease, but the only risk seems to be to your wallet.
What should I do now?
If you're over the age of 40, not taking a statin, and you have ever had:
Heart problems
A stroke
A ministroke
Blockage in the arteries of the legs or neck
Diabetes
you may want to ask your doctor if this study applies to you. You should keep in mind that there may be other reasons your doctor will choose not to prescribe a statin, but it's certainly reasonable to ask.
Originally reviewed by:
Beth Israel Deaconess Medical Center. Reviewed for medical accuracy by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. BIDMC does not endorse any products or services advertised on this Web site.
Original Publication Date: November 2001
Reviewed by Charlotte E. Grayson, MD, WebMD, February 2002.
Unscrambling the News About Eggs
American Heart Association Advice: Eggs Have a Place in a Healthy Diet
By Jeanie Davis
WebMD Medical News
The simple egg isn't the hard-boiled nemesis it used to be. Bedeviled by years of bad press, the egg's reputation has finally turned for the better. Amazing it didn't crack under the pressure.
"Eggs are back," says Donald J. McNamara, PhD, executive director of the Egg Nutrition Center in Washington, D.C. "They're not the bad guys we used to think they were."
Thirty years ago, eggs were virtually banned from the American diet because of their cholesterol content.
Cholesterol does play a role in heart disease -- "but today, we know that the cholesterol in eggs plays a very minor role," McNamara tells WebMD. "It's saturated fat in the diet that has the biggest impact" -- that's fast food, deep-fried foods, fatty meats, high-fat dairy products, junk food.
So, What Should You Eat?
"We want people to eat more vegetables and fruit, more whole grains, more fish, more low-fat dairy products, and to reduce the saturated and trans-fat foods," says Barbara Howard, PhD, chairwoman of the American Heart Association's Nutrition Committee. Trans-fats are found in margarine and many other fried and baked products.
"Eggs can fit into a healthy, balanced diet," she tells WebMD.
In fact, a Harvard study published in The Journal of the American Medical Association two years ago looked at the egg/coronary heart disease issue. Researchers found that consumption of up to one egg per day did not have a significant impact on risk for heart disease or stroke.
The AHA's advice: We should eat 300 mg or less of cholesterol in a day's time. An egg has 200 mg of cholesterol.
"Think of your diet as a budget, like your monthly checkbook allowance," Howard tells WebMD. "If you eat an egg during the day, make sure you eat fewer of the other foods that have cholesterol in them, like butter, high-fat dairy products, and meats."
A Hidden Benefit
More egg-citing news: Those yellow egg yolks contain lutein, a caroteinoid that may protect against the development of hardening of the arteries (atherosclerosis) which leads to heart disease and other disorders, according to a recent study published in Circulation: Journal of the American Heart Association. Lutein has also been shown to protect against age-related macular degeneration (a vision condition that can cause blindness) and to improve long-term memory function. Lutein is also found in deep yellow-colored fruits and vegetables.
The emphasis is on eating a balanced diet -- not on eating an egg a day, she says.
Howard adds: "For seniors, it's a very easy product to prepare, easy to chew and digest, and there are not a lot of calories."
Eggs are a high-quality source of protein, 13 essential vitamins and minerals, significant amounts of vitamin B-12, vitamin D, and folate. Eggs also contain choline, an essential nutrient involved in brain function. Choline is transferred to the fetus and newborn, and research indicates it is essential for development of brain centers and long-term memory centers, says McNamara.
Thankfully, salmonella -- a cramping, diarrheal type of infection -- is no longer a big problem in the egg world, McNamara says. "Our industry has incorporated a lot of quality assurance programs over the last 10 years. Salmonella has gone down 48% in the last six years."
Chickens are being vaccinated against salmonella, which has shown to be effective. Also, many eggs are pasteurized before they hit the market. McNamara quotes CDC figures: One egg in 20,000 is internally contaminated. "If you eat a raw egg every single day for 54 years, you wouldn't run into one egg with salmonella."
Only raw and undercooked eggs present the biggest salmonella risk, he says. "The FDA estimates that in food service, maybe as much as 20% are slightly undercooked, so they might be a risk."
But come Easter Sunday, those boiled eggs -- as pretty as they are -- should spend most of their time in the fridge, McNamara advises. "You have to treat it like any perishable product. If you leave it out for two hours, you run the risk that it's contaminated."
Originally published March 29, 2002.
Reviewed by Charlotte E. Grayson, MD, WebMD, April 2002.
Facts About Cholesterol
WebMD Medical Staff
Is the cholesterol in egg yolks the "good" or "bad" kind? Can you "burn" cholesterol by exercising? Which has more cholesterol, a tablespoon of butter or a cup of peanut butter?
Most people know that fat is bad for them, but two-thirds of Americans are confused about how cholesterol differs from fats. The fat issue is actually the most clearly defined topic in nutrition. Yes, most Americans should cut the fat. They need to do it now and for the rest of their lives, for the sake of their hearts, health and waistlines.
The Facts about Cholesterol
Can You Burn Off Cholesterol?
Cholesterol is a type of lipid, just as fats are. However, unlike fat, cholesterol can't be exercised off, sweated out or burned for energy. It is found only in animal products, including meat, chicken, fish, eggs, organ meats and high-fat dairy products.
Is Cholesterol Good or Bad?
Just as homemade oil-and-vinegar dressing separates into a watery pool with a fat-slick topping, so also would fats and cholesterol if they were dumped directly into the blood. To solve this dilemma, the body transports fat and cholesterol by coating them with a water-soluble "bubble" of protein. This protein-fat bubble is called a lipoprotein.
Low-density lipoproteins (LDLs) carry cholesterol to the tissues. This is "bad" cholesterol, since high LDL levels are linked to increased risk for heart disease.
High-density lipoproteins (HDLs) carry excess cholesterol back to the liver, which processes and excretes the cholesterol. HDLs are "good" cholesterol; The more HDL you have, the lower your risk for developing heart disease.
HDLs and LDLs are found only in your blood, not in food.
Test Your Cholesterol
Your risk for heart disease can be assessed with a blood-cholesterol test. In this test, your total-cholesterol reading should approximate the sum of your LDL, HDL and other lipoproteins. If you have 3.5 mg of total cholesterol, or less, for every 1 mg of HDLs, then your cholesterol ratio is ideal. According to guidelines from the National Cholesterol Education Program:
Total cholesterol should remain below 200 mg/dL, unless HDL is high.
LDL should be lower than 130 mg/dL.
HDL should be 40 mg/dl or higher.
However, if you have any risk factors for heart disease, you'll want to get your LDL even lower, less than 100 is optimal
The Fat Primer
The fats that supply calories, float in your blood and accumulate in your thighs and hips are called "triglycerides." They can be saturated or unsaturated, and the unsaturated ones can be either monounsaturated or polyunsaturated. For every ounce of triglycerides you eat, you add 250 calories (or 9 calories per gram -- the weight of a raisin) to your diet. Only saturated fats increase blood levels of cholesterol and heart-disease risk.
Which Ones Are Saturated?
In general, the harder a fat, the more saturated it is. Beef and dairy fats are mostly saturated fats. Liquid oils are usually unsaturated fats, including monounsaturated fats in olive and canola oils and polyunsaturated fats in safflower, corn, soybean and fish oils. Coconut, palm and palm kernel oils are exceptions to the rule; these liquid vegetable oils are highly saturated fats.
Fear of Frying
Eating foods with a lot of saturated fat raises your risk for heart disease; this causes the amount of bad LDLs in your blood to increase while good HDLs decrease. Cut the saturated fat, and your blood-cholesterol levels and your risk for heart disease drop. Your risk for cancer also decreases. A diet with more polyunsaturated fats, rather than saturated fats, lowers total blood-cholesterol levels, but unfortunately also drops HDL levels, so you lose both good and bad cholesterol. Olive oil is another story. This oil lowers total-blood cholesterol and LDL cholesterol without causing HDL levels to drop. By using olive oil, you can decrease your total-cholesterol levels while maintaining your HDL levels, thus decreasing your risk for heart disease. Fish oil also lowers heart-disease risk. Consequently, olive and fish are the oils of choice.
Trans, Schmans
Hydrogenated fats are liquid vegetable oils made creamy when manufacturers convert some of the unsaturated fats into saturated ones through a process called "hydrogenation." This process also rearranges the molecular shape of the remaining unsaturated fats. The resulting shape is an abnormal "trans" shape.
Trans fatty acids constitute up to 60 percent of the fat in processed foods containing hydrogenated fats. TFAs raise blood-cholesterol levels and increase heart-disease risk just like saturated fats. Knowing your fats gives you an edge when it comes to buying and preparing the right foods to eat. And when you steer away from the saturated fat and trans fatty acids, you can live a heart-healthy life. The bottom line is:
Eat less fat, especially saturated fat.
Limit your intake of fatty meats, fatty dairy products and processed foods that contain hydrogenated vegetable oil.
Use olive oil, but in moderation if you're watching your weight.
Fill your plate with fruit, vegetables, whole grains, fish and legumes.
The Power of Lifestyle Changes
By Dean Ornish, MD
for WebMD Health
Heart and blood vessel diseases account for more premature deaths each year than nearly everything else combined. Yet heart disease is preventable and even reversible for most people.
We tend to think of advances in medicine as a new drug, surgical technique, something high-tech and expensive. Yet the choices we make each day -- what we eat, how we respond to stress, how much we exercise, whether we smoke, and our relationships with others -- can make powerful differences in our health and well-being.
You don't have to make such big changes to prevent heart disease as to reverse it. Here's how you can customize a diet and lifestyle program that's just right for you:
Steps To Take
If your total cholesterol level is consistently below 150 mg/dL or your LDL cholesterol is below 95, either you're not eating much fat and cholesterol, or your body is good at getting rid of it. Either way, your risk of heart disease is low.
If it's above these levels, begin cutting back on dietary fat and cholesterol. If that's enough to bring it down, great; if not, then continue cutting back until you reach the desired goals. If you're not interested in making bigger changes in diet and lifestyle, talk with your doctor about whether cholesterol-lowering drugs are right for you. Many, perhaps most people, can avoid these drugs if they make bigger changes in diet and lifestyle than what many doctors recommend.
What you include in your diet is as important as what you exclude. When go from a high-fat, high-cholesterol diet rich in animal protein to a low-fat, whole foods, plant-based diet, you get a double benefit. You reduce your intake of disease-promoting substances and you get at least 1,000 substances that help protect against heart disease, cancer, and other illnesses. These substances are found mainly in fruits, vegetables, grains, beans, and soy products. Folate, in grains and green vegetables, reduces homocysteine levels, which decreases cardiac risk. Three grams per day of flax seed oil or fish oil contain omega-3 fatty acids that may reduce the incidence of sudden cardiac death by more than 50%.
Making Connections
It's not just diet. Studies show that people who feel lonely, depressed, and isolated are much more likely to get sick and die prematurely than those who have feelings of love, connection, and community. People who are lonely and depressed are more likely to smoke, overeat, drink too much, and work too hard as a way of coping, numbing, and distracting themselves. As one patient told me, "I have 20 friends in this package of cigarettes and they're always there for me, and no one else is."
Also, depression and loneliness cause premature death through mechanisms we don't fully understand. One study showed that six months after a heart attack, more than five times as many depressed patients were dead compared with those who weren't depressed. Depression is highly treatable, so it's important to reach out for help.
Stress isn't just what you do -- more important is how you react to what you do. Yoga and meditation can help you react to stress on the job or at home in a healthier way. Even a few minutes a day can make a big difference.
Working It Out
Moderate exercise provides most of the health benefits of more intense exercise. Walking 20-30 minutes a day can reduce risk of premature death by 50%.
Concepts such as "risk factor modification" and "prevention" are considered borrrrrrring by many people. They wonder, "Am I going to live longer, or is it just going to seem longer?"
When you make big changes in diet and lifestyle, you may feel so much better, so quickly, the choices become clearer. Not just to live longer, but also to live better -- for joy of living, not fear of dying. Your brain may get more oxygen, so you may think more clearly and have more energy. Your skin gets more blood, reducing wrinkles and other signs of premature aging. Even sexual organs often receive more blood flow, just as Viagra works.
When you change your diet and lifestyle, blood flow to the heart can improve quickly. If you quit smoking, within five years your risk of having a heart attack falls almost as low as if you had never smoked. Your body has a remarkable capacity to begin healing itself if you give it a chance.
Dean Ornish, MD, is founder and president of the nonprofit Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco.
Askari A. Kazmi
Consultant
CONTROLING THE CHOLESTROL....WHY?
Interesting people, histories of WWI and WWII, comic books, video games, train stations.