Depression and Cardiovascular Disease

Depression in women older than 50 is strongly linked to a higher risk of dying from heart disease. Researchers in the Women's Health Initiative looked at the relationship between depression and heart health. Of the 93,676 women studied, nearly 16% scored high on the depression scale. Death from heart disease was 50% higher among the depressed women over the next 4 years compared to those with low depression scores.

Overall mortality from any cause was also higher. They found a 32% increase in mortality in the depressed women. This increased risk of death linked to depression remained after adjusting for age, race, BMI, physical activity, and other possible confounding risk factors.

Depression as an independent risk factor for heart disease is a new finding. The researchers were not able to explain why or how it affected the heart. The researchers concluded, however, that this study provides strong evidence of a link between depression and heart risk in women and needs further study. Doctors are now encouraged to screen for depression in their heart patients and to take therapeutic steps when indicated. (PP slides available below on this study.)

Depression and Cardiovascular Sequelae in Women, Archives of Internal Medicine, Feb. 9, 2004

Cancer Prevention

The U.S. Senate (resolution 252) recently designated February as Cancer Prevention Month. Cancer is one of the most prevalent and devastating diseases in the United States, affecting over 550,000 deaths annually.

The good news is that many, if not most, cancers are preventable by making lifestyle changes and screening for early detection and treatment before the cancer spreads.

A Healthy Diet and lifestyle can prevent cancer by as much as 70% according the the National Cancer Institute (NCI) sponsored Institute for Cancer Prevention. For example:

• 30-35% of cancers are caused by poor diet (low in fruits and vegetables, dietary fiber, etc.
• One large study found that people who exercised and were physically fit had only half the mortality from cancer as unfit people
• About 30% of all cancers are caused from smoking
• Recent studies link obesity to 14-20% of all cancers
• Alcohol is responsible for at least 3% of all cancer deaths
• Environmental factors, such as exposure to pollution, also raise risk
• Death from colorectal cancer is estimated to be 90% preventable by getting colonoscopies and other screening exams.
• Screening exams for cervical cancer, prostate cancer, and breast cancer can also lower mortality rate.

Dr. Bernard Levin, vice president for cancer prevention at MD Anderson Cancer Center at the University of Texas, comments about the new Cancer Prevention Month. "It is a step in the right direction ... it focuses our attention on the personal steps we can take to reduce our risk of developing cancer including regular physical activity, maintenance of an appropriate body weight, and never to use tobacco in any form."

Resolution sponsor Senator Ernest Hollings said, "We have made great advances in recent years in our understanding of cancer and the steps that individuals can take to prevent it. From improved nutrition and exercise to smoking cessation and appropriate screening procedures, there is much every person can do to decrease their risk of developing cancer."

The World Health Organization recently set dietary guidelines for cancer prevention world wide. Here is a brief summary of their guidelines:

• Maintain a healthy weight, BMI < 25, and avoid weight gain, no more than 10 pounds during your adult life.
• Maintain regular physical activity. The primary goal should be to perform physical activity on most days of the week; 60 minutes per day of moderate-intensity activity, such as walking. More vigorous activity may give some additional benefits for cancer prevention.
• Consumption of alcoholic beverages is not recommended.
• Limit salt-preserved meats and fish.
• Eat plenty of fruits and vegetables, at least 400 grams per day of total fruits and vegetables (at least 5 servings daily).
• Those who are not vegetarian are advised to limit consumption of preserved meats such as sausage, salami, bacon, and ham.
• Do not consume foods or drinks when they are very hot.
• Avoid exposure to aflatoxin (from mold) in food.

WHO, Diet, Nutrition and the Prevention of Chronic Disease, 2003
M.D. Anderson Cancer Prevention Center, Univ of Texas,  Cancer News and Information, Feb, 2004

Poor Control of Risk Factors in Diabetics

Diabetes, one of the fastest growing diseases in America, is particularly hard on the heart and vascular system. The American Diabetes Association and the National Diabetes Education Program (NDEP) have set target goals to minimize the major complications from diabetes. These goals are:

• Maintain a HbA1c level less than 7% (indicating good control of blood glucose levels).

• Maintain a blood pressure less than 130/80 (high glucose and high blood pressure creates a high risk to the cardiovascular system).

• Keep blood cholesterol levels low, less than 200 for everyone, 160 mg/dL or lower in diabetics.

To see how well our health care system was meeting these goals, researchers at the National Institute of Diabetes looked at compliance in a large group of diabetics using the NHANES 2000 data (a random sampling of people and their health within the United States). Their findings indicate poor compliance (see graph).

• 63% of diabetics did not meet the HbA1c goal (less than 7%)

• 64% of diabetics did not meet the blood pressure goal (<130/80)

• Over half (52%) had cholesterol levels higher than goals for the general public (<200 mg/dL) let alone levels of 160 or below.

• Overall, only 7% of diabetics in the U.S. meet these 3 key goals for preventing serious health consequences from diabetes.

With the costs for treating diabetes and its complications already exceeding $132 billion annually, the authors of this study project a rapid increase in costs in future years unless doctors and their patients work diligently to improving compliance through lifestyle change and better medical care.

Poor Control of Risk Factors in Diabetics, JAMA 291:335-42, January 21, 2004

Moderate Fat May be Better than Low Fat Diet

A low fat diet has long been recommended to lose weight. Recent research, however, suggests that a moderate fat intake may work as well and has additional benefits to the heart.

Researchers put overweight individuals on a low fat (18% of calories) and a moderate fat (33% of calories) diet for 6 weeks to lose weight. Then for the next 4 weeks they ate to maintain their new weights. Both groups lost a similar amount of weight but the group on the moderate fat intake had more favorable results in markers for heart health.

Persons on the low fat diet lowered LDL cholesterol and HDL cholesterol (lower HDL cholesterol means an increase in risk). Those on the moderate fat intake also lowered LDL cholesterol but in contrast, their HDL levels remained steady. They also saw other improvements in cardiovascular health such as lower blood fat levels on the moderate fat intake compared to the low fat intake.

Their conclusion: A moderate fat diet (using primarily monounsaturated fats) works well for losing weight, is easier to stick to for most people, and has more cardiovascular benefits compared to the low fat diet. They recommended using olive and peanut oils for stir frying, and adding nuts, avocado, and olives to salads to incorporate healthy fats into the diet. (More information on this study.)

American Journal of Clinical Nutrition, February 2004

Social Support and Heart Health

Men who have good friendships with many people are less likely to develop heart disease. In a 15-year Swedish study of 741 men (age 50+) researchers found that men who had the highest levels of social integration -- meaning that they had many quality friends -- cut their risk of a heart attack by 55% compared to those men with the least social integration. This amazing difference continued even after adjusting for smoking, exercise, weight, and blood pressure.

This study adds to the growing body of knowledge that social support and integration promote heart health and survival. Another study looking at depression and heart disease found that happily married men and women were less likely to develop cardiovascular disease. In addition, if they did have a cardiovascular condition, they had better survival rates.

A third study on marriage extending life was made by the University of Pennsylvania. Their four year study found that happily married patients with congestive heart failure had better survival rates than patients with more contentious marriages. In fact, they found that the quality of the marriage relationship was as good a predictor of survival as the medical classification of the severity of their illness.

A good marriage and healthy friendships are key ingredients to survival and a long, fulfilling life.

Marriage can be good for the heart, HeartCenterOnline feature, Feb 12, 2004
Prognostic importance of marital quality for survival of heart failure, Amer J of Cardiology, 88:526-529

New Guidelines on Sodium and Potassium in the Diet

The Food and Nutrition Board of the Institute of Medicine (IOM), has released their long awaited guidelines for intake of sodium (salt) and potassium in the diet. The bottom line is that we need to eat less sodium and more potassium to achieve healthier blood pressure levels in America, to decrease formation of kidney stones, and to decrease bone loss.

The old standard for sodium was to eat less then 2400 mg of sodium daily. The new standard for adults 19-50 years old is to limit sodium intake to 1500 mg/day (or 3.8 grams of salt). The tolerable upper limit of salt intake is now set at 5.8 gm/day. Currently, 90% of American men and 75% of women already exceed this upper limit, let alone reach the recommended amount. We simply eat far more salt than is good for us.

At the same time, we need to eat more potassium. The new potassium recommendation is to eat at least 4.7 gm/day. Most Americans eat only half this amount. Potassium is found in fresh fruits and vegetables.

One way to make a quick change is to use "Lite" salt which is lower in sodium and higher in potassium (it is a mixture of 60% potassium chloride and 40% sodium chloride). Also read food labels. Watch out for high sodium levels in canned foods, canned tomato products, canned beans, chips, processed foods, restaurant foods, and pickled foods. See Health Links for more information.

IOM, Food and Nutrition Board, DRIs for Water, Potassium, and Sodium, Feb. 2004

Antibiotics and Breast Cancer Risk

A press release by the National Cancer Institute highlights a new study linking antibiotic use to increased risk of breast cancer. Women who used antibiotics at least 25 times over the past 17 years (or for more than 500 days) had more than double the risk of breast cancer. Those women who used antibiotics only once or more (but less than 25 times) had a 50% increased risk compared to women who never used antibiotics. The researchers concluded that the more antibiotics the women in the study used, the higher their risk of breast cancer.

The researchers cautioned that there may be times when antibiotic use is needed but they also cautioned not to take antibiotics for the common cold and flu because antibiotics are not effective against viruses anyway. Their use needs to be reserved for serious health conditions where antibiotics are indicated. The over use of antibiotics has been a long time concern by the Centers for Disease Control and Prevention (CDC). Read the press release and Q & A (Health links) listed below for further information.

NIH News, National Cancer Institute, Press Release Feb. 17, 2004

New Insights into Insulin Resistance

Two new studies this month give insight into how to prevent insulin resistance, which eventually results in type 2 diabetes. The first study looked at dietary factors related to insulin resistance in the Framingham Offspring Study including 2,834 people.

Those people who had a low intake of dietary fiber, particularly fiber from whole grains, had the highest levels of insulin resistance (a high resistance leads to diabetes). Those people with the highest glycemic load also had higher insulin resistance.

The researchers concluded that whole-grain intake and a low glycemic load help prevent both insulin resistance and metabolic syndrome. Both conditions are linked to high risk of developing diabetes and coronary heart disease.

The second study on insulin resistance and diet was from the PREMIER study which was designed to lower blood pressure. They had two experimental trials plus a control group. Experimental group A included weight loss, reduced sodium (salt) intake, and increased physical activity. Experimental group B did the same but included the DASH diet. The DASH dietary pattern is high in fruits and vegetables (8-10 serving/day), uses low or nonfat dairy products, and was lower in red meats, saturated fat, and cholesterol.

Both experimental groups worked on making these lifestyle changes for 6 months. Insulin resistance was measured at the beginning and end of the study. Group A showed some improvement but the changes were not significant. Group B, including the DASH diet, had a significant improvement in insulin resistance -- nearly a 50% improvement.

Researchers concluded that the DASH diet high in fruits and vegetables and low in animal fats not only improves blood pressure but also enhances insulin action beyond the effects of exercise and weight loss.

What is the bottom line? To help prevent insulin resistance, metabolic syndrome, and diabetes:

• Eat whole grain breads and cereals

• Include more fresh fruits and vegetables in your diet (up to 8-10 servings daily). They are high in nutrients and low in calories.

• Choose low glycemic load meals (avoiding a high in take of sugars, white bread, snack foods, potatoes, white rice, soda pop and other high glycemic foods).

Carbohydrate Nutrition and Insulin Resistance, Diabetes Care 27:538-46, Feb 2004
PREMIER Interventions on Insulin Resistance, Diabetes Care 27:340-47, Feb. 2004

Fitness and C-Reactive Protein

High levels of C-reactive protein in the blood indicates inflammation and high risk for coronary heart disease. One large study in women showed that C-reactive protein was even a better predictor for future heart attacks than LDL cholesterol.

A study of diabetic women in their 50s looked at fitness levels and C-Reactive protein levels. They tested women on a treadmill and then divided them into two groups based on the median fitness level. Those above median fitness were termed high fit and those below median fitness were termed low fit.

Next they compared blood levels of C-reactive protein between the two groups. The low fit women's C-reactive protein levels were 3.3 times higher than the fit women even though there was no significant difference in their blood lipid levels. (See graph of study.)

This study illustrates that aerobic fitness is a very important factor for reducing the risk of heart disease, especially in diabetics.

Diabetes Care 27:320-325, Feb. 2004

Dietary Fiber and Heart Disease

Studies continue to be released showing the benefits of eating high fiber foods. The newest study links fiber from fruits and whole grains to less heart disease. Ten large population studies were combined to include 91,058 men and 245,186 women. The rate of heart attacks and deaths from heart disease were tracked for 6-10 years.

Results. For each 10 g/day increase in dietary fiber, deaths from heart disease dropped by 27%. Fruit fiber was most closely linked to lower mortality rates followed closely by fiber from grains. Fiber from vegetables was not linked to decreased heart disease but has benefits for other health conditions.

This means that if you want to cut your risk of heart disease by 25-50%, just include 10-20 more grams of dietary fiber in your diet daily. If you are aiming for 8-10 servings of fruits and vegetables daily plus 4+ servings of whole grains you should be reaching the dietary goal of 38+ g/day of fiber for men and 26+g/day for women. Look for cereals that have at least 5g of fiber per serving. Here is a brief chart of fiber in common foods.

Dietary Fiber and Risk of CHD, Archives of Internal Medicine 164:370-376, Feb. 23, 2004

Two New Diabetes Risk Factors

Two new risk factors for diabetes were reported this month. The first study looked at dietary practices. The study group included 2,285 men and 2,019 women. Researchers assessed their eating habits and discovered who develop diabetes over a 23 year period.

Here is what they found. People who ate the highest levels of vitamin E (from foods) had a third (31%) less diabetes than those who ate the least (compared top 20% of vitamin E intake to lowest 20%).

This is exciting news. One simple dietary change may cut the risk of diabetes by a third! What foods are high in vitamin E? Here are some of the highest: wheat germ, sun flower seeds, hazelnuts, vegetable oils, and whole grains. They also found another antioxidant (beta-cryptoxanthin), a carotenoid, that was also protective. Those eating the most of this antioxidant had a 42% decreased risk of developing diabetes. Foods high in this carotenoid are dark yellow foods including citrus, mango, peach, and tangerine. These are all healthy foods and may be helpful in preventing diabetes.

The second study identifying a new risk factor for diabetes included 11,615 healthy adults followed for 6 years. At baseline all persons were evaluated for depression. Those people in the highest quartile (tip 25%) for depressive symptoms had a 63% increased risk of developing diabetes during the 6 year follow-up compared to the 25% for people with the fewest depression symptoms.

This predictive relationship persisted even after adjusting for smoking, physical activity, calorie intake, BMI, blood pressure, and other possible confounders. Researchers are not sure why depression is a predictor nor do they understand a mechanism yet, but there appears to be a strong mental component in increasing the risk of diabetes. Screening for depression is important for many reasons besides diabetes risk, but it may be an additional clue to why some people develop diabetes. (If interested, take a depression screening test (see health links) to see how you rate.)

Diabetes Care 27:429-435, Feb. 2004
Diabetes Care 27:362-366, Feb. 2004

QuickFacts  Important health facts you need to know and share.

Exercise and Brain Power. Adults 58 to 78 who started an exercise program and gradually worked up to a 45 minute walk three times weekly showed significant improvement in mental performance documented both by mental tests and by magnetic resonance imaging (showing increased brain activity). Exercise for physical and mental fitness!
Arthur Kramer of the Beckman Institute for Advanced Science and Technology at Illinois

Screen for obesity. The US Preventive Services Task Force now recommends that all doctors screen their patients for obesity by determining their BMI and taking a waist girth measurement. If BMI is 30+ or waist girth is 35+ inches for women or 40+ inches for men they recommend intensive counseling and intervention for weight loss. About one in every five adults (21%) is obese. 
Annals of Internal Medicine, Dec. 2, 2003

Echinacea. When studied carefully in 407 children, Echinacea failed to relieve cold symptoms any better than a placebo. Study conclusions, "We did not find any group of children in whom Echinacea appeared to have a positive benefit."
University of Washington's Child Health Institute, Study appeared in JAMA Dec. 3, 2003

Alcohol. Alcohol, in small amounts, has long been touted as good for the heart. New research from John Hopkins University found that even moderate alcohol intake increased brain atrophy. They studied the brains of 1,909 people using an MRI. Researchers found that as drinking increased, brain atrophy was more common. They concluded that alcohol is clearly a risk factor for brain atrophy.
John Hopkins University, published in Stroke, Dec. 5, 2003

Sugar. The average American eats about 150 pounds of sugar every year. 60 pounds of sugar come from high fructose corn syrup (HFCS) used in soft drinks, cookies, cake, and candies. HFCS is stored as fat more readily than sucrose or table sugar.  NEJM Editors, HealthNews, May 2003

Colon Cancer. Colon cancer screening at 12 VA hospitals of more than 3000 people aged 50-75 found that 10% already had advanced precancerous polyps. If 50 or older, have you had your colonoscopy yet? They also found that those who ate at least 8 grams of fiber from whole grains daily were only about half as likely to have advanced polyps compared to those who ate little fiber. 
Dept of Veteran Affairs Medical Center Portland Oregon, published in JAMA, Dec 9, 2003

Depression. Diabetics were twice as likely to suffer from depression in a large study of diabetics compared to similar age individuals without diabetes. When health care costs were analyzed, those who had both diabetes and depression had medical expenses 4.5 times higher than those with just diabetes.  Diabetes Care 25:464-470, 2002

Fitness.  Keeping fit while a young adult greatly influences health status in mid-life says a new study looking at fitness and health in nearly 5000 adults 18-30 years old. After 15 years of follow-up, those who did not keep fit (bottom 20% of the group) had 3 to 6 times the risk of developing high blood pressure, diabetes, and metabolic syndrome compared to those who were fit (top 40%). Developing risk factors for heart disease and strokes are not just the natural result of aging. One of the best ways of protecting your health is to keep fit. Aim for 30-60 minutes of moderate physical activity daily.  (more...)
Fitness in Young Adults and Development of CVD Risk factors, JAMA, Dec. 17, 2003

Low carb diets. A recent survey now estimates that 24 million Americans are now on a "low carbohydrate diet". Doctors warn that a high saturated fat diet low in whole grains, fruits, and vegetables is not balanced and may lead to heart and kidney disease. Cutting out unhealthy carbs (soda pop, white bread, snacks, chips etc.) is admirable but for good health the body needs healthy carbs (whole grains, brown rice, vegetables, legumes, and fresh fruit) daily.  Wall Street Journal, Feb. 19, 2004

Food-borne Illness.  Handling, preparing, and storing food properly to avoid contamination, growth of bacteria, or formation of toxins in food is important to our daily health. Notice these statistics presented by Mark McClellan MD, PhD, FDA commissioner in an address at Harvard School of Public Health. Food born illness accounts for 76 million illnesses, 325,000 hospitalizations, 5,200 deaths, and over $23 billion in potentially avoidable health care cost each year! (more...) 
Food and Drug Administration web site, July 1, 2003

Power Point Slides

The following slides are taken from studies reviewed in this newsletter and are available to view and download for your use in presenting health information in your local health promotion programs. Do not copy slides to distribute to other people.

• Fitness in young adults prevents diabetes, metabolic syndrome, and high blood pressure 7 years later

• Dietary fiber and coronary heart disease

• Poor control of risk factors in diabetics

• Preventing metabolic syndrome - role of glycemic index and whole grains

• High fitness levels results in lower C-reactive protein levels

Featured Health Links

Antibiotics and Breast Cancer Q & A. Learn more about this study. A National Cancer Institute web page.  NCI press release.

Get Smart: Know when Antibiotics Work.  A CDC site stressing the dangers of overuse of antibiotics.

Preventing Food-borne Illness. A guide prepared by the FDA

New Guidelines for intake of sodium (salt), potassium, and water intake by the NAS, Institute of Medicine

Understanding Depression Screening Center. An excellent site set up by the University of Michigan. Take the depression screening test to see how you are doing. Also includes information about dealing with depression.

Clearing The Air - Stop Smoking Guide. Prepared by NIH, National Cancer Institute (NCI). An excellent 35 page booklet (PDF). Also see
SmokeFree.gov an online stop smoking site prepared by NCI.

The Healthy Heart Handbook for women. An excellent guide for heart health designed especially for women by NIH. 108 page book (PDF).

Your Guide to Eating Out (Healthfully). Prepared by American Diabetes Association. Gives tips for choosing healthier meals when eating out.

Depression and Diabetes. Prepared by National Institute of Mental Health. Explains how diabetes and depression often go together.

Healthy Recipes

Looking for something new and good to eat? Here are a few ideas for you to try that are tasty and good for you!

• Steel Cut Oat Cereal - Oats are high in fiber that protects against diabetes and heart disease. Steel cut oats are a low glycemic index food
• Garbanzo Noodles - A quick, hearty soup.
• Island Soybeans - A quick, delicious entree with a tropical flair.
• Savory Split Pea Soup - A rich flavored soup with 8 grams of protein per serving

New Nutrition Handouts

A new 3-fold brochure entitled "Healthy Eating Guidelines" is available for use in nutrition, weight control, and wellness education programs. It includes:

• 10 healthy eating guidelines designed to improve health and prevent disease
• New Food Pyramid
• Practical ideas for improving nutrition

Posters of the New Food Pyramid are available in 8.5 X 11 and 11 X 17 in. poster size. These materials can be used for National Nutrition Month (in March) in your organization.  They are available and ready to order. Ask your Wellsource sales representative or Carol Marlow at LifeLong Health 503-656-7446 ext. 233