REPORTING POINT 04-03
HEALTH NEWS
“Live healthy...live well”
by Larry Kline
SWAPA Voice Mailbox 511/email: skyguy737@cox.net
HOW TO BE A GOOD BARBECUE HOST - British researchers examined data on almost 5,000 intestinal disease outbreaks in the 1990's, and discovered that most were caused by salmonella in food eaten at social functions such as parties and barbeques. Food safety experts note that parties are especially likely sources of food poisoning because cooks are not used to preparing food for so many people, because their attention is taken away by other aspects of the party, or because food is left out too long at room temperature.
To send your friends home healthy, follow these tips from the American Dietetic Association:
-Wash your hands in warm, soapy water for 20 seconds before preparing any food and after handling raw meat, poultry, eggs or seafood. Dry with paper towels or clean cloth towels. Clean all countertops, appliances, cutting boards, and utensils with hot soapy water. Disinfect sponges in a bleach solution or just throw them out.
-Never let ready-to-eat foods come in contact with anything (including plates, utensils, cutting boards, or countertops) that has touched raw meat without cleaning them first.
-Cook all foods thoroughly; use a meat thermometer for meat and poultry.
-Do not leave food out for more than two hours, or one hour in hot weather. If you cannot refrigerate within this time period, toss the leftovers. Men's Fitness 4/02.
THE TOTAL CHOLESTEROL PICTURE - you may think you are taking good care of your heart - exercising, eating right, and having your cholesterol checked - and your cholesterol numbers may be good - you and your doctor may be satisfied and not concerned. But consider this;
-the landmark Framingham Heart Study, which has been tracking thousands of people since 1948, found that 80 percent of those who develop coronary disease have the same basic cholesterol numbers as those who don’t.
-at least 50 percent of arteriosclerosis (narrowing of the arteries) can’t be explained by the standard risk factors (smoking, diet, lifestyle, high cholesterol). There are other agents at work that routine lab tests miss.
-for 25 percent of men with a family history of cardiovascular problems, the first sign of heart disease is sudden death.
Despite all the advances in heart disease treatment within the last decade (new drugs, surgeries, preventions), it remains the country’s number one killer of both men and women. Over 60 million Americans (one in every five) has some form of it, and each year 725,000 men and women die of it - the equivalent of one victim every 44 seconds! Although science has arrested its growth, there is still no sign of a drastic reduction in the incidence of the disease.
Statistics like these contradict the impression most people develop at the doctor’s office, where basic cholesterol numbers, treadmill stress tests, and lifestyle factors have been the standard predictors of risk and benchmarks for treatment. On its website, the American Heart Association (AHA) encourages people to think of high cholesterol as a “leading risk factor for heart disease...a vital sign, similar to blood pressure.” It makes the following recommendations:
-total cholesterol - below 200 milligrams per deciliter (mg/dl)
-HDL (good cholesterol) - above 35 mg/dl
-LDL (bad cholesterol) - below 130 mg/dl
-triglycerides - below 200 mg/dl
These four components of cholesterol, the “basic panel”, are the only ones the AHA mentions. When blood-test results fall within these guidelines, most doctors will probably conclude that there is no heart disease risk. Conversely, when these numbers exceed the boundaries, most doctors will recommend lifestyle changes and possibly some cholesterol-lowering drugs. There is some impressive recent research that challenges the current conventions and dependability of these guidelines:
-total cholesterol - derived from a study of 360,000 men, researchers found that 24 percent of those who died of heart attacks had total cholesterol levels below 200. One of these researchers believes that “total cholesterol is really a very bad test...if you’re judging the health of your heart by it, you’re way off.”
-HDL - according to data from the Framingham Study, the average HDL cholesterol of men with coronary artery disease was 43. That is 23 percent higher than what the guidelines say is protective.
-LDL - based on data from Framingham, the average LDL cholesterol of those having heart attacks was 150 - the guidelines call that only “borderline high” risk.
-triglycerides - researchers from Framingham and other studies suggests that the AHA’s threshold is too lenient. Keeping it below 150 appears to be the new consensus for safety.
For these reasons and more, the basic cholesterol panel can predict coronary artery disease in only 20 percent of cases. Many doctors recommend an LDL less than 100, and HDL over 45, and triglycerides less than 150. Most people do not fit into these categories; for those who don’t, there are new blood tests that can give better indications of risk.
The typical blood test gives a general reading of total low-density lipoprotein. There are seven different types of LDL, some of which are more dangerous than others. They may cause heart attacks in the following manner:
1. From childhood onward, a high-fat diet and sedentary lifestyle increases the LDL in the bloodstream. The smallest, densest particles (IIIa and IIIb) are the most likely to enter into artery walls and cause lesions.
2. Bigger, less dense LDL particles (I, IIa, IIb, IVa, and IVb) can add to the damage, over time, calcifying into plaque.
3. One day, a piece of plaque breaks off and rides the bloodstream into the heart or wedges in a blood vessel, clogging it. Starved of oxygen, the heart muscle shuts down, resulting in a heart attack.
Small, dense lipoprotein, the worst of the seven types of LDL cholesterol, can now be measured. It is very hazardous because it is the most likely of all the particles to get into artery walls and plaques. This creates arterial lesions, contributes to the growth of existing ones, and may make plaque less stable and more susceptible to rupture. The combined results of three major studies found that small, dense lipoprotein conveys a threefold increase in cardiovascular risk.
The second substance is called lipoprotein(a), or Lp(a) for short. This is a form of LDL that is so predictive of coronary disease that it has been called “heart-attack cholesterol.” Researchers at Oxford University in England found that among 5,400 people with heart disease, those with the highest levels had a 70 percent greater chance of having a heart attack.
There are other rarely-measured blood components that can have similar dire consequences. Even though the mechanisms by which they all work are not fully understood, clinical evidence is mounting that they play influential roles in heart disease. How vital depends on family history and lifestyle influences.
The Framingham Study had for decades been citing connections between many of these components and heart disease (fibrinogen in 1987, homocysteine in 1990, and lipoprotein(a) in 1994). If these risk factors are known, why aren’t they being utilized in analyzing heart risk?
Most cardiologists are concerned with removing arterial clogs, but traditionally they haven’t offered much advice on keeping arteries clean - they treat what they can see, not what is potential.
Also, insurance may not pay for it. Although the price of these blood tests is much cheaper than the bill for a bypass, health insurance plans do not typically reward prevention.
The antidote to many of these newly-discovered hazardous particles is the B vitamin niacin. It reduces triglycerides and LDL cholesterol (including Lp(a) and small, dense lipoprotein) at the same time it raises beneficial HDL. Niacin can be more effective at treating these risk factors than popular cholesterol-lowering drugs, which tend to act more generally on total cholesterol and gross LDL. Niacin has serious side effects (possible liver damage at high doses) and should be taken only under a doctor’s supervision.
Doctors often rely on drug-company salesmen for information about new treatments. Because niacin has historically been the prescription when these new numbers are out of line, there are no drug companies that can financially benefit from niacin being prescribed.
Currently, only about 5 percent of doctors recommend these expanded blood indicators. The tests are not cheap, but are very revealing:
Apoprotein B - this is the protein cap that each LDL particle “wears”. By counting them, there is a precise measure of the LDL particles in the bloodstream, a truer indication of the genetic predisposition to heart disease. These particles may damage the arteries and cause blockages, so it helps to know how many are present. The maximum level recommended is 100 mg/dl.
Lipoprotein(a) - this “heart-attack cholesterol” accumulates around arterial lesions and promotes clogging. Lp(a) alone can raise the risk of heart attack by as much as 70 percent. Also, it does not respond to diet and exercise. Niacin is the best way to treat it. Levels below 20 mg/dl are recommended.
Fibrinogen - this is a protein molecule that promotes clotting and also thickens the blood. The more there is, the greater the likelihood that the heart is struggling to pump “sludge”. High levels seem to correlate with cigarette smoking, obesity, inactivity, aging, and diabetes. Levels above 350 (mg/dl) double the risk of coronary disease.
C-reactive protein - this substance is produced in the liver when arteries become inflamed. The more of it there is, the greater the chance of arterial plaque rupturing and causing a heart attack. Levels above 2.5 mg/dl convey a two-to-fourfold increase in risk and are capable of predicting first heart attacks 6 to 8 years in advance.
Homocysteine - this is an amino acid that promotes clotting. It appears to work in conjunction with fibrinogen and Lp(a). Levels above 14 can increase the risk of heart attack and stroke by two to four times. Fortunately, it is one of the easiest of the new blood components to control - it responds well to folate and B vitamins.
Insulin - this is the hormone secreted by the pancreas to regulate blood sugar. Testing for insulin is not new, but it is important. When combined with high triglycerides, low HDL, high fibrinogen, and high levels of small, dense, lipoprotein, high insulin levels strongly predispose one to atherosclerosis - this should be under 12 mcg/ml.
LDL IIIa and IIIb - there are seven subclasses of LDL particles (I, IIA, IIB, IIIa, IIIb, Iva, and IVb). Overall, LDL is bad cholesterol, but IIIa and IIIb are the most destructive types. These are the smallest, densest particles - ones most likely to work their way into artery walls and form plaques. People with lots of small, dense lipoprotein are dubbed pattern B and have a threefold greater risk of developing heart disease.
HDL2b - there are five subclasses of HDL particles, labeled 2a, 2b, 3a, 3b, and 3c. Overall, HDL is good cholesterol, but 2b is the most beneficial. The more you have of it, the less likely you are to suffer a heart attack.
If you would like more information on these blood tests and your doctor will not recommend them, contact the Berkeley HeartLab (800-432-7889) for a referral. Men’s Health 6/01.
THE ABC's OF AMINO ACIDS - amino acids are the building blocks of protein, which in turn are the building blocks of muscle:18 amino acids make up what is considered a " complete " protein, the type found in foods such as beef, chicken, milk, eggs and protein powder. "Essential" amino acids are those that the body cannot manufacture on its own and thus needs to acquire them from dietary sources.
Branched-chain amino acids are composed of leucine, isoleucine, and valine, three of 18 amino acids that make up a complete protein. Athletes who weight-train regularly may consider supplementing to insure adequate amino acids that may provide extra energy during heavy training, may spare muscle tissue from being used as fuel, and fight mental sluggishness from endurance workouts. Men's Fitness 4/02.
THE JOY OF SOY - Part III - consuming soy and soy products regularly may help stave off Alzheimer’s disease. Health 7/01.
BEATING ALZHEIMER’S - speaking of outsmarting Alzheimer’s disease, researchers at Case Western Reserve University interviewed more than 500 older people about their lifelong participation in dozens of activities, from gardening to bowling to walking. They found that people who had been relatively sedentary throughout their lives were more than twice as likely to have Alzheimer’s disease compared with people who had been active. This doesn’t prove a cause-and-effect relationship between exercise and the disease, but it fits with other studies that have found a lower instance of Alzheimer’s among people who have led active lives. Health 7/01.
