Study Confirms Health Benefits of Whole Grains

A diet high in whole grain foods is associated with a significantly lower risk of developing cardiovascular disease, including heart disease and stroke, according to an analysis conducted by researchers at Wake Forest University School of Medicine.

“Consuming an average of 2.5 servings of whole grains each day is associated with a 21 percent lower risk of cardiovascular disease compared to consuming only 0.2 servings,” said Philip Mellen, M.D., lead author and an assistant professor of internal medicine. “These findings suggest that we should redouble our efforts to encourage patients to include more of these foods in their diets.”

These results were published on line in Nutrition, Metabolism & Cardiovascular Diseases and will appear in a future print issue.

The findings are based on an analysis of seven studies involving more than 285,000 people. By combining the data from these seven studies, researchers were able to detect effects that may not have shown up in each individual study. The studies were conducted between 1966 and April 2006.

Mellen said the findings are consistent with earlier research, but that despite abundant evidence about the health benefits of whole grains, intake remains low. A nutrition survey conducted between 1999 and 2000 found that only 8 percent of U.S. adults consumed three or more servings of whole grain per day and that 42 percent of adults ate no whole grains on a given day.

“Many consumers and health professionals are unaware of the health benefits of whole grains,” said Mellen.

A grain is “whole” when the entire grain seed is retained: the bran, germ and the endosperm. The bran and germ components are rich in fiber, vitamins, minerals, antioxidants, and healthy fats. These are the parts removed in the refining process, leaving behind the energy-dense but nutrient-poor endosperm portion of the grain. Examples of whole grain foods include wild rice, popcorn, oatmeal, brown rice, barley, wheat berries and flours such as whole wheat.

In addition to protecting against cardiovascular disease, which accounts for one-third of deaths worldwide, there is evidence that whole grains also project against diabetes and other chronic conditions.

“Years ago, scientists hypothesized that the higher rates of chronic diseases we have in the West, including heart disease, are due, in part, to a diet full of processed foods,” Mellen said. “Subsequent studies have born that out – especially with whole grains. Greater whole grain intake is associated with less obesity, diabetes, high blood pressure, and high cholesterol – major factors that increase the risk for heart disease and stroke.”

According to nutritionists, consumers should look for “100 percent whole grain” on food labels or look for specific types of whole-grain flour as the main ingredient, such as “whole wheat.”

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The Reason Behind Cold, White Fingers and Toes

There’s a medical reason behind cold fingers and toes, when a chill seems to instantly turn extremities white.

The May issue of Mayo Clinic Health Letter explains the likely cause: Raynaud’s (ray-NODES) disease, a disorder of the blood vessels.

Exposure to cold normally results in slowing of blood flow to fingers and toes. Small arteries in extremities narrow, reducing blood flow and preserving the core body temperature. For people with Raynaud’s disease, the response is exaggerated for unknown reasons. The small arteries constrict dramatically, most often in the fingers and toes, but the nose, ears and cheeks also can be affected. The constriction, called vasospasm, can last for a little as a minute or as long as several hours. Stressful emotions can trigger vasospasm, too.

There’s no known cause of Raynaud’s, which most often first occurs between teen years and about age 40. In some cases, it is linked to diseases that can damage blood vessels or nerves, such as scleroderma, lupus or rheumatoid arthritis.

In many cases, Raynaud’s doesn’t cause any permanent damage. Some people with severe Raynaud’s do experience tissue destruction and should seek medical treatment to manage the condition. Medications that relax blood vessels and promote circulation can help. They include calcium channel blockers, alpha blockers and bosentan (Tracleer). Most people with Raynaud’s find the condition can be uncomfortable but managed with lifestyle changes such as dressing to avoid chills. And Raynaud’s disease is yet another reason to avoid cigarettes. Nicotine constricts blood vessels.

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Frequent Urination = Underlying Health Problem

An increase in the number of trips to the bathroom — day or night — is a signal it’s time to see a physician. Frequent urination often indicates an underlying medical condition. With proper diagnosis and treatment, it’s possible to return to normal urinary habits.

The May issue of Mayo Clinic Health Letter covers some of the common causes of frequent urination:

Urinary tract infections: Symptoms of a bacterial infection of the bladder or the urethra — the tube that allows urine to flow out of the body from the bladder — can include burning with urination, foul-smelling urine, fever and pelvic pain.

Side effect of medication: Diuretics and other medications can increase urinary frequency.

Age-related changes: Weakening of the muscles of the bladder, urethra and pelvic floor many lower the amount of the urine the bladder can store as well as the ability to hold or properly eliminate urine.

Prostate problems: For men, an enlarged or infected prostate can lead to urgency and frequent urination, especially at night.

Radiation treatment: Treating cancers near the bladder (rectum or pubic bone cancers) may damage the bladder wall. The urgency or frequency that may result usually diminishes within a few weeks to a year.

Bladder problems: Frequent or urgent urination can be an early sign of bladder cancer. Bladder stones or bladder inflammation also can cause frequent or painful urination.

Diabetes: When excess blood sugar is excreted into urine, it draws water from the body’s tissues, increasing the need to urinate.

Kidney disease: Diseases that cause kidney decline may affect the kidneys’ ability to concentrate urine, increasing the amount of urine produced.

A weak heart due to heart failure: A weak heart can’t pump blood efficiently, causing fluids to build up in the body. The kidneys work to rid the body of excess fluid, causing large amounts of urine production and frequent urination.

The key treatment for frequent urination is addressing the underlying condition.

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Cutting Calories, Not Exercise = Holding Weight Loss

Cutting Calories, Not Exercise, Plays Bigger Role in Maintaining Weight Loss

The weight loss mantra of UAB’s (University of Alabama at Birmingham) EatRight Weight Management system is ‘reduce calories and increase exercise’. But new research from EatRight suggests that for those who have been successful at losing weight, reducing calories is an effective way to keep weight off, especially when it is difficult to find time to exercise. In findings published in the May issue of Obesity, the researchers report that 80 percent of EatRight participants maintain their weight loss during two years of follow up, and most do it primarily by sticking to a low calorie, low energy density diet.

“Our results show that individuals who successfully maintain body weight after completing EatRight consume fewer calories and have a lower energy density dietary pattern than those who do not maintain body weight,” said Jamy Ard, M.D., assistant professor of nutrition sciences and medical director of EatRight Weight Management Services. “This calorie control led to successful weight maintenance despite the fact that these individuals did not meet recommended exercise levels.”

Ard and colleagues followed 89 former EatRight participants for two years. The 80 percent who had successfully maintained their weight loss consumed fewer calories than those who gained weight, and tended to eat a diet consisting of low energy density foods, such as fruits, vegetables and whole grains. A low energy density diet means an individual can eat more yet take in fewer calories than with high energy density foods.

“While the importance of physical activity is well established, our study demonstrates that adopting a lower calorie, low energy density dietary pattern may reduce the amount of physical activity that is truly necessary for weight maintenance,” said Tiffany Cox, M.P.H., program coordinator for the EatRight follow-up study. “This could have a positive long term effect on weight maintenance by giving individuals a more easily attainable physical activity goal, which they may be more likely to pursue.”

Ard says research indicates that failing to reach an exercise goal can cause a decrease in self-efficacy and self-satisfaction, eventually causing individuals to cease exercising altogether.

“It’s clear that exercise combined with a low energy density diet is the best approach for weight loss and overall good health,” said Ard. “But many people report finding time to exercise is a major obstacle. It’s encouraging to report that weight loss can be maintained primarily through a low calorie diet.”

EatRight, created at UAB more than 30 years ago, is based on the concept of time-calorie displacement, which encourages a substantial intake of foods that have fewer calories by volume such as fruits, vegetables and whole grains, while limiting consumption of foods that are calorie-dense such as meats, cheeses, sugars and fats.

The EatRight model includes increasing physical activity and incorporates behavioral intervention to reduce or remove barriers to lifestyle change and achievement of goals. Typically, it is conducted in 12 weekly small class sessions. For more information on the UAB EatRight Weight Management Services, go to http://www.eatright.uab.edu

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Women: Cholesterol Lowering Drugs vs. Heart Disease?

Women in western countries are more likely to die from heart disease than from cancer. In this week’s British Medical Journal two experts debate whether women should be offered cholesterol lowering drugs as a preventive treatment.

For women who are at moderately high risk of heart disease, use of drugs should not be ruled out, argues Professor Scott Grundy from the University of Texas.

There is general agreement that both men and women with established cardiovascular disease are at high risk and should get intensive cholesterol lowering therapy.

The essential question here is whether women as well as men should be considered for drug therapy when they do not have established cardiovascular disease, but who are deemed to be at moderately high risk, according to the guidelines.

Trials involving both men and women at moderately high risk have shown overall risk reduction from cholesterol lowering therapy, but not enough women were included to provide a definitive result, he explains.

Until a large-scale clinical trial is carried out to test the efficacy of cholesterol lowering in women at moderately high risk, drug therapy should be avoided in most lower risk women, he says. But in those who have multiple cardiovascular risk factors and who are projected to be at moderately high risk, use of drugs should not be ruled out.

But GP Malcolm Kendrick disagrees. Not only do statins fail to provide any overall health benefit in women, they represent a massive financial drain on health services, he says.

He believes the evidence of benefit is not strong enough. He points out that, to date, none of the large prevention trials has shown a reduction in overall mortality in women, and one suggested that overall mortality may actually be increased. This, he says, raises the important question whether women should be prescribed statins at all.

Statins also represent the single greatest drug expenditure in the National Health Service, he says. In 2006, the cost in England was £625m and is expected to reach £1bn in 2007. This money could be diverted to treatments of proved value.

Some studies also suggest that statins carry a substantial burden of side effects, he adds.

He concludes that spending hundreds of millions on a treatment that has no proved benefit and may cause serious harm goes against the rationale of evidence based prescribing.

View Grundy article: http://press.psprings.co.uk/bmj/may/feat982.pdf
View Kendrick article: http://press.psprings.co.uk/bmj/may/feat983.pdf

Click here to view full contents pages for this week's print journal: http://press.psprings.co.uk/bmj/may/contents1205.pdf

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Young women don't see heart attack warning signs

Most women 55 years and younger who have heart attacks don't recognize warning signs, researchers reported at the American Heart Association's 8th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

Women younger than 55 years represent less than 5 percent of all hospitalized heart disease patients, but because so many heart attacks occur in the United State each year, even this small percentage affects a large number of people. Young women with heart disease account for about 40,000 hospitalizations each year. Diseases of the heart in young women account for about 16,000 deaths annually, ranking it among the leading causes of death in this group, according to authors.

"The number of young women who die from coronary heart disease each year is roughly comparable to the number of women who die of breast cancer in this age group," said Judith Lichtman, Ph.D., lead author of the study. "Studies have shown that young women with heart disease are twice as likely to die in the hospital as similarly aged men. While these statistics are startling, relatively little is known about the clinical presentation, care or outcomes of young women with heart disease."

In a pilot study, Lichtman and colleagues studied 24 women (55 and younger) who had heart attacks and were admitted to one of two Connecticut hospitals. The researchers asked them about their symptoms before the heart attack and whether they recognized or understood that they were at risk for heart disease.

Nearly 90 percent of the women in the study had the typical heart attack symptom of chest pain, with 7.4 being the average rating of their chest pain on a scale of one to 10 (with 10 being the most painful).

"This means that they were experiencing significant chest pain," said Lichtman, an assistant professor in the Department of Epidemiology and Public Health at Yale School of Medicine in New Haven, Conn. Researchers said they were surprised that only 42 percent, or four in 10, of the women who came into the hospital thought something was wrong with their hearts. "Many of them told us that they thought they had indigestion or heartburn," Lichtman said.

The women also reported other less typical symptoms:

58 percent said they had pain in the jaw or shoulder
38 percent reported sweating
29 percent experienced nausea
29 percent reported shortness of breath
21 percent said they had indigestion or heartburn
8 percent felt weakness or fatigue
Only about half of the women went to an emergency room within the first hour of their symptoms.

"When we asked the women why they delayed going to the hospital, half of those who waited more than an hour said they were afraid their symptoms weren't real; about 42 percent attributed their symptoms to something else; about 17 percent said they were embarrassed by their symptoms; and 8 percent admitted that they feared the symptoms or experienced denial that it could be heart disease," Lichtman said.

The researchers also found that about 88 percent of the women had a family history (a parent or sibling) with heart disease. Even though 71 percent said their health was fair/poor, less than half considered themselves at risk for heart disease.

The researchers said doctors may be failing to link many young women's symptoms to heart disease. Prior to their heart attacks, 38 percent saw their primary providers for some or all of their symptoms; yet, only 56 percent of those women said their doctors told them their symptoms were heart-related.

"It seems that many young women are not connecting their symptoms with heart disease, even more are simply unaware of the possibility that they are at risk for a heart attack," Lichtman said. "We have to get the messages across to young women that they are at risk for a heart attack, they might experience not only typical but also atypical symptoms, and they need to be aware of their own risk factors, including family history. Prevention and modification of risk factors is important for young women. "

To avoid possible permanent damage to the heart muscle, young women, like their older counterparts, must seek prompt care if they have symptoms. They also must be persistent with their health providers — especially if they have risk factors, including high blood pressure, high cholesterol, obesity, smoking, inactivity, diabetes and family history, Lichtman said.

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Pregnancy: Keep Cool & Get Exercise with Precautions

Summer isn’t the most fun time to be pregnant – heat and sweat add to the ordinary discomfort of pregnancy, and hormonal changes can make women less able to regulate body temperature. But it’s still important for pregnant women to get healthful exercise, 30 minutes a day, three to four times a week, says Dr. Diane Hughes, an obstetrician/gynecologist at UT Southwestern Medical Center.

“By taking some simple precautions, and knowing the early signs of overheating, pregnant women can maintain their health even through hot weather,” Dr. Hughes said.

Avoiding overheating is especially important in early pregnancy, when the fetus is going through critical developmental stages. For that reason, pregnant women should not use hot tubs or saunas.

Among Dr. Hughes’ tips are:

• Drink plenty of water, about eight to 10 glasses a day. Enjoy cold treats such as frozen fruit pops, but keep an eye out for junk ingredients such as added sugar.
• Consult with your doctor about an exercise plan. If you exercise outdoors, do it in the cool parts of the day.
• Get in the water. Swim, take frequent cool showers or baths, lounge in a kiddie pool, carry a spray bottle to spritz yourself with, or sit with your feet in a basin of cool water.
• Wear loose, light-colored clothing in natural fibers. When exercising, wear clothing that wicks moisture away from skin.
• If you begin to feel bad while exercising, stop. Seek medical help for racing pulse, nausea, dizziness, blurred vision, vaginal bleeding, a temperature higher than 100.4 degrees Fahrenheit or mental confusion.

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