The Daily HIT

Exercise brings many health benefits but its stand-alone effects on weight loss are less than some have claimed.

From today’s New York Times:

“The message of our work is really simple,” although not agreeable to hear, Melanson said. “It all comes down to energy balance,” or, as you might have guessed, calories in and calories out. People “are only burning 200 or 300 calories” in a typical 30-minute exercise session, Melanson points out. “You replace that with one bottle of Gatorade.”

This does not mean that exercise has no impact on body weight, or that you can’t calibrate your workouts to maximize the amount of body fat that you burn, if that’s your goal.

“If you work out at an easy intensity, you will burn a higher percentage of fat calories” than if you work out a higher intensity, Carey says, so you should draw down some of the padding you’ve accumulated on the hips or elsewhere — if you don’t replace all of the calories afterward. To help those hoping to reduce their body fat, he published formulas in The Journal of Strength and Conditioning Research last month that detailed the heart rates at which a person could maximize fat burning. “Heart rates of between 105 and 134” beats per minute, Carey said, represent the fat-burning zone. “It’s probably best to work out near the top of that zone,” he says, “so that you burn more calories over all” than at the extremely leisurely lower end.

Perhaps just as important, bear in mind that exercise has benefits beyond weight reduction. In the study of obese people who took up exercise, most became notably healthier, increasing their aerobic capacity, decreasing their blood pressure and resting heart rates, and, the authors write, achieving “an acute exercise-induced increase in positive mood,” leading the authors to conclude that, “significant and meaningful health benefits can be achieved even in the presence of lower than expected exercise-induced weight loss.”

Plenty of room for improvement here, obviously. Pre-term births figure prominently, for reasons not yet well understood.

Most of the deaths are among pre-term infants and the United States has a very high rate of pre-term births, according to the report from the National Center for Health Statistics.

“In 2005, the latest year that the international ranking is available for, the United States ranked 30th in the world in infant mortality, behind most European countries, Canada, Australia, New Zealand, Hong Kong, Singapore, Japan, and Israel,” the NCHS, part of the Centers for Disease Control and Prevention, said in the report.

“One in 8 births in the United States were born preterm, compared with 1 in 18 births in Ireland and Finland,” added the report, available at http://www.cdc.gov/nchs/data/databriefs/db23.htm.

“If the United States had Sweden’s distribution of births by gestational age, nearly 8,000 infant deaths would be averted each year and the U.S. infant mortality rate would be one-third lower.”

A new study from Singapore shows a protective effect of soy for hip fractures. The effect is noted in women but not men.

Postmenopausal women may lessen their chances of fracturing a hip by adding soy-based foods to their diet, a study from Singapore hints.Women in the study were 21 to 36 percent less likely to fracture a hip when they reported eating a moderate amount of soy, Dr. Woon-Puay Koh, at the National University of Singapore, and colleagues found.

In their study, daily moderate soy intake was at least 2.7 grams of soy protein, 5.8 milligrams of soy isoflavones per 1000 calories, or the equivalent of 49.4 grams of tofu.

This level of soy is consistently “higher than the low levels of consumption in the West,” Koh told Reuters Health in an email.

A varied whole foods diet has numerous preventive effects. One of them relates to the likelihood of developing depression. The data is from Great Britain but the dietary issues certainly apply in the U.S., as well.

From the BBC:

The team said the study was the first to look at the UK diet and depression.

The UK population is consuming less nutritious, fresh produce and more saturated fats and sugars Dr Andrew McCulloch, Mental Health Foundation

They split the participants into two types of diet – those who ate a diet largely based on whole foods, which includes lots of fruit, vegetables and fish, and those who ate a mainly processed food diet, such as sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products.

After accounting for factors such as gender, age, education, physical activity, smoking habits and chronic diseases, they found a significant difference in future depression risk with the different diets.

Those who ate the most whole foods had a 26% lower risk of future depression than those who at the least whole foods.

By contrast people with a diet high in processed food had a 58% higher risk of depression than those who ate very few processed foods.

Hopefully this is just the beginning of the blowback against the deal between the American Academy of Family Physicians and the Coca-Cola Corporation.

Yesterday, 20 family physicians in Contra Costa County, California,  ripped up their membership cards in the American Academy of Family Physicians in protest over the AAFP’s partnership with Coca-Cola.

The director of the Contra Costa Department of Health Services, Dr. William Walker, announced that he was resigning his 25-year membership in AAFP.

Dr. Walker said:

…I am appalled and ashamed of this partnership between Coca-Cola and the American Academy of Family Physicians. How can any organization that claims to promote public health join forces with a company that promotes products that put our children at risk for obesity, heart disease and early death.

…The AAFP is supposed to be an organization that works to protect the health of children not put them at risk. Their decision to take soda money is all the more unconscionable because, unlike doctors in the 40s, they well know the negative health impact of soda. There is no shortage of documentation that soda is a major contributor to our nation’s obesity epidemic.

…Let me be clear about something: as disappointed as I am with the American Academy of Family Physicians for being duped into thinking that Coca Cola wants to help promote health, the real problem here is our children are being put at risk.

Companies like Coca Cola are polluting our communities with deceptive advertising promoting products that put our children’s health at risk.

…as a family practice doctor and the Health Officer for Contra Costa, I do have a prescription for every parent, teacher, community leader and student:

Look beyond the glitzy advertising that makes you think pouring liquid containing sugar into your body is healthy. Read the label. Look at the ingredients. I’m not suggesting that you boycott sugared drinks, but please make an informed decision about what you are consuming.

I’m calling on every city and neighborhood in our County to fight back against the industry that pushes these harmful products. I ask the American Academy of Family Physicians to end this unhealthy partnership and to join us in leading this important campaign to take back the health of our residents and end the obesity epidemic.

Major news on hypertension from this week’s meeting of the American Society of Nephrology on the relationship between high-fructose corn syrup (HFCS) and hypertension. Because HFCS is being added to thousands of processed foods in the United States, this calls for a major rethinking of priorities.

A diet high in fructose increases the risk of developing high blood pressure (hypertension), according to a paper being presented at the American Society of Nephrology’s 42nd Annual Meeting and Scientific Exposition in San Diego, California. The findings suggest that cutting back on processed foods and beverages that contain high fructose corn syrup (HFCS) may help prevent hypertension.

Over the last 200 years, the rate of fructose intake has directly paralleled the increasing rate of obesity, which has increased sharply in the last 20 years since the introduction of HFCS. Today, Americans consume 30% more fructose than 20 years ago and up to four times more than 100 years ago, when obesity rates were less than 5%. While this increase mirrors the dramatic rise in the prevalence of hypertension, studies have been inconsistent in linking excess fructose in the diet to hypertension.

Diana Jalal, MD (University of Colorado Denver Health Sciences Center), and her colleagues studied the issue in a large representative population of US adults. They examined 4,528 adults 18 years of age or older with no prior history of hypertension. Fructose intake was calculated based on a dietary questionnaire, and foods such as fruit juices, soft drinks, bakery products, and candy were included. Dr. Jalal’s team found that people who ate or drank more than 74 grams per day of fructose (2.5 sugary soft drinks per day) increased their risk of developing hypertension. Specifically, a diet of more than 74 grams per day of fructose led to a 28%, 36%, and 87% higher risk for blood pressure levels of 135/85, 140/90, and 160/100 mmHg, respectively. (A normal blood pressure reading is below 120/80 mmHg.)

“These results indicate that high fructose intake in the form of added sugars is significantly and independently associated with higher blood pressure levels in the US adult population with no previous history of hypertension,” the authors concluded. Additional studies are needed to see if low fructose diets can normalize blood pressure and prevent the development of hypertension.

It has long been known that both steroidal and nonsteroidal anti-inflammatory drugs (NSAIDs) are risky in higher doses or when used long-term.

One key side effect of these medications are that they wear away the lining of the stomach and thus lead to gastric ulcers. Another is that they wear down the articular cartilage at joints. The latter is particularly ironic because one of the most common reasons for using NSAIDs is to treat joint pain.

Now a new study indicates that even smaller, shorter-term use of naproxen (best known as Aleve) increases hospitalization rates for ulcers.

It’s worth mentioning that if this particular NSAID causes this kind of problem at these doses, it is a major mistake to assume that the solution is just to switch to a different over-the-counter (OTC) NSAID.

With so many people taking these pills as a normal part of life, I want to provide a longish quote from today’s Medpage report:

Even at low doses, naproxen (Aleve, Anaprox, Naprosyn, Naprelan) may increase the risk of upper gastrointestinal complications, researchers said here.

Patients taking a 500-mg/day dose had a 2.5-fold increased risk of hospitalization from complicated gastric or duodenal ulcer, while those on the 750-mg/day dose had almost a threefold increased risk, Gurkirpal Singh, MD, of Stanford University, and colleagues reported at the American College of Gastroenterology meeting.

The 1,000-mg/day dose carried more than a threefold increased risk of hospitalization.

“We found that naproxen use is not safe even at lower doses,” Singh said. “We need to be careful about prescribing it, even in lower doses.”

The lowest doses are available over the counter.

In large studies comparing other nonsteroidal anti inflammatory drugs (NSAIDs) and COX-2 inhibitors, naproxen has been associated with fewer serious cardiovascular risks. That led to several recommendations for naproxen to be the drug of choice for patients with heart problems, the researchers said.

Kathy Freston has just posted an illuminating interview with Dr. Caldwell Esselstyn about the nutritional causes of heart disease. Esselstyn worked for decades as a surgeon at the Cleveland Clinic and speaks with the voice of wisdom and experience.

Beginning in 1985 I initiated a study of seriously ill coronary artery disease patients. Their nutrition became plant based without oil. Their cholesterol levels plummeted. Their angina disappeared. Their weight dropped. I have reported this study at 5 years, 12 years, and 16 years, in the peer reviewed scientific literature and again beyond 20 years in my book Prevent and Reverse Heart Disease. In some of the patients we had follow up angiograms (x-rays) of previously blocked arteries demonstrating striking disease reversal, which is a testament to my often quoted statement “The truth be known coronary artery disease is a toothless paper tiger that need never exist and if it does exist it need never progress.” The greatest gift to these patients is the increasing recognition that they are the locus of control for their disease – not some pill or procedure. They have made themselves heart attack proof and lose the greatest fear of all heart patients and their families – when will the next heart attack occur?

As someone who loves vegetables but is not a big fan of cauliflower, this cartoon by Tom Piraro hits very close to home. From his blog, www.bizarrocomic.blogspot.com.

It’s always good to see validation of low-tech, low-cost (in this case, NO cost) approaches to challenging health problems. 

Drinking a half-gallon of water a day may keep gout attacks away, researchers said here. 

Participants in an online survey who said they drank more than eight 8-ounce glasses of water a day experienced a 48% reduction in gout attacks, compared with individuals who reported drinking one glass of water or less a day, according to Tuhina Neogi, MD, PhD, assistant professor of medicine at Boston University School of Medicine.

“We think that drinking water might be a simple, safe, and effective way of preventing recurrent gout attacks,” Neogi told attendees at the American College of Rheumatology’s annual meeting here.