Obesity and Heart Disease

Posted Posted in Continuing Education, Homestudy, Nutrition

thick-373064_640By Dr. Mary O’Brien MD

Longitudinal studies clearly indicate that obesity predicts coronary atherosclerosis in men and in women. Hypertension, a leading cause of atherosclerosis, is approximately three times more common in obese individuals than in those who are of normal weight or less than normal weight.

Body mass index (BMI) is one of the most effective ways to measure obesity. Some studies show that a BMI that is between 25 and 30 confers as much as a 70 percent increased risk of coronary heart disease.

However, a high BMI may not entirely predict heart disease risk. In women, a BMI near 30 may still not be of major concern when the increase in fat tissue is distributed over the hips and not the abdomen.  Accumulating evidence indicates that an increased waist circumference, or waist-to-hip ratio (WHR), predicts complications and mortality from obesity.

Weight-reduction seems to be effective in reducing risks of coronary heart disease (CHD) and congestive heart failure (CHF), potentially preventing heart disease in obese patients. Evidence indicates that, for obese patients, a reduction of only five percent to 10 percent of body weight improves lipid profiles, insulin sensitivity, and endothelial function.  Such a reduction also reduces thrombosis and inflammatory markers.

Maintaining a BMI of less than 25 throughout adult life is a good strategy to reduce the risk of heart disease. For most patients with a BMI between 25 and 30, lifestyle changes in diet and exercise are appropriate.

Restricting consumption of fat to less than 30 percent of total calories should be recommended, because low-fat diets also promote weight reduction. Physical training programs can reduce body mass and help bring about gradual weight loss.

Medical therapy may be necessary in patients with a BMI higher than 30. However, the safety of long-term use of anti-obesity medications has not been established. When the BMI falls within the range of 35 to 40 (or above), bariatric surgery may be an option. Unfortunately, less than five percent of patients are able to maintain their reduced weight four years after surgery. Thus, the prevention of obesity with diet and regular physical activity appears to be the most dependable way to maintain cardiovascular health.


Dust Mites and Allergies

Posted Posted in Continuing Education, Homestudy, Webinars

mite-67638_640By Rajinder S. Hullon, M.D., J.D.

Distantly related to spiders, dust mites are tiny organisms that cannot be seen with the naked eye. They feed on dust containing human skin flakes and primarily live in places that tend to collect dust:  such as carpets  and upholstered furniture —  and even sheets, pillows, blankets, and mattresses. As many as 90% of people who have allergic asthma are allergic to dust mites. Some people are allergic to live dust mites as well as the decayed bodies of dust mites and their fecal material, often found in household dust.

Symptoms of dust mite allergy typically include: repeated and prolonged sneezing, an itchy, stuffed-up nose, a watery nose, and watery eyes. The eyes, throat, mouth, and even the ears may itch.

Reducing household dust and humid environments, where dust mites thrive, can alleviate or eliminate allergic symptoms.

It can be nearly impossible to eliminate dust mites entirely, but here are some ways to decrease dust allergens in your home:

  • Keep humidity as low as possible, preferably less than 50%. Eliminating any water leaks or sources of moisture around the house, particularly in the basement, will also help make your home more inhospitable to mold.
  • Use air-conditioning properly. Air-conditioning can effectively lower the humidity level; filters should be changed and cleaned on a regular basis.
  • Replace surfaces where dust mites can proliferate, such as carpeting as well as upholstered furniture  that has smooth surfaces. In particular, avoid using wall-to-wall carpeting.
  • Remove stacks of paper, blankets, and similar dust catchers. Store blankets in sealed plastic bins or bags in a closet or a room apart from living areas.
  • Use dust-mite impermeable covers for pillows, mattresses, and bed covers.
  • Wash bedding in water hotter than 130˚F at least once a week. This kills mites.
  • Vacuum and dust often, especially in bedrooms.


Because most dust mites are concentrated in surface dust, not airborne dust, air cleaners and filters are not very effective in reducing these allergens. Ion and ozone generators can remove dust particles from the air, but not from surfaces, where dust mites are most apt to be found. Ozone generators, which produce ozone at levels 10 times above what the U.S. Code of Federal Regulations specifies as safe, should be avoided.


Vacuum cleaners stir up dust, so wearing a dust mask when vacuuming can reduce allergen exposure. Newer Higher Efficiency Particle Arresting (HEPA) vacuums may not actually reduce the number of dust mite allergens, but the vacuum cleaners can reduce the amount of small-particle dust that vacuuming generates. This, in turn, reduces the amount of inhaled dust containing dust mites and their droppings.


An allergist-immunologist will ask about your:

  • medical history.
  • eating habits.
  • home and work environments.
  • pets.

A blood test may be ordered to confirm dust mite allergy diagnosed on the basis of a scratch test. The doctor performs this test by painting a small patch of diluted dust mite allergen onto the patient’s back or forearm and then uses a needle to scratch the skin beneath the allergen. Swelling or redness that develops within 15 to 30 minutes indicates that the patient’s immune system has responded to the allergen.

Allergy shots and prescription medicines may provide relief for patients with persistent symptoms.


Can Loss Of Sleep Make Us Fat?

Posted Posted in Continuing Education, Homestudy, Psychology, Webinars

buddha-85673_640Laboratory and epidemiological studies suggest that sleep loss may play a role in the increased prevalence of diabetes and obesity. The relationship among sleep restriction, weight gain, and diabetes risk may involve alterations in glucose metabolism, upregulation  of appetite, and decreased energy expenditure. Shorter periods of sleep are associated with decreased glucose tolerance and increased concentrations of blood cortisol. Research has suggested that long-term sleep restriction (less than 6.5 hours per night) may cause a 40 percent fall in glucose tolerance.

An association between short, habitual sleep time and increased BMI  has been reported in large populations. Short sleep was associated with changes in hormones that control hunger. Specifically, leptin levels were low  while ghrelin levels were high. These effects were seen when sleep duration fell below eight hours. This suggests that sleep deprivation is a risk factor for obesity. One controlled study with healthy males found that a sleep time of around four hours was associated with significantly greater craving for calorie-dense foods with high carbohydrate content (sweets, salty foods, and starchy foods). Reported hunger was also higher.

One could also argue that less time spent sleeping would allow for more time for eating and drinking. This could certainly be a contributor to a general obesogenic environment. On the other side of the energy equation, sleep-deprived people are less likely to be physically active, resulting in lower energy expenditure. Taken together, the increases in appetite and food craving and decreases in activity create a compelling argument for understanding  the role of sleep deprivation in weight management.


Food, Calcium, and Bone Health

Posted Posted in Continuing Education, Elder Care, Homestudy, Nutrition

CalciumFoods_ML1512_ts481492527By Barbara Boughton

Once a woman hits menopause, getting enough calcium for bone health becomes a major concern. Women over age 60 are prone to osteoporosis — and the spinal, hip, and knee fractures that osteoporosis can bring. Yet adequate dietary calcium can help protect people from osteoporosis.  Taking calcium supplements can help as well.

It’s not just menopausal women who should be concerned about getting enough calcium. As consumption of sugary soft drinks has risen among children and teenagers, intake of milk has also declined. But children and teenagers who are able to eat and drink enough calcium-enriched foods—as well as take in sufficient protein during meals—benefit from improved skeletal growth and bone mass. In fact, studies show that children who avoid, for prolonged periods, drinking calcium-containing milk have an almost three-fold higher risk for fracture than age-matched birth cohorts.

Dairy products are considered to be the easiest and cheapest sources of dietary calcium. Most people should have three to four servings of milk products daily in order to improve bone health and prevent osteoporosis. Studies have estimated that increasing dairy intake to three to four servings per day can reduce osteoporosis-related healthcare costs in the U.S. by $3.5 billion per year.

As well as calcium, it’s important to get enough calcium to enhance calcium absorption. What are your calcium and vitamin D requirements? Adults up to age 50 should get 1,000 mg of calcium and 200 International Units (IUs) of Vitamin D. Those over age 50, should intake at least 1,200 mg of calcium and 400 to 600 IUs of vitamin D each day.

Among foods with calcium, some are better than others for bone health. Yogurt is one of the best. It contains a hefty dose of calcium (415 mg per serving of plain, low-fat or non-fat per eight-ounce serving).  Many varieties of yogurt are also fortified with vitamin D. Some brands of fat-free, plain yogurt contain 30 percent of the adult daily requirements for calcium and 20 percent of the adult daily requirements for vitamin D. Although protein-packed Greek yogurts are popular right now—because of their reputed health benefits—they are less useful than other yogurt types for staving off osteoporosis. Greek yogurts contain less calcium than other types of yogurt and very little vitamin D.

Besides dairy products — such as low-fat and non-fat milk, yogurt, and cheese — there are other foods that are good for your bones. Canned sardines and salmon are rich sources of calcium, and fatty fish such as salmon, mackerel, tuna, and sardines are also replete with vitamin D. Some vegetables contain a generous amount of calcium, including collard greens, turnip greens, kale, okra, Chinese cabbage, dandelion greens, mustard greens, and broccoli. Foods fortified with calcium and vitamin D—such as some juices, breakfast foods, soy milk, rice milk, cereals, and breads—can also add to the health of your bones.

The foods with the highest amounts of calcium are:  plain low-fat yogurt; calcium-fortified orange juice; low-fat fruit yogurt; skim mozzarella cheese and cheddar cheese; canned sardines; reduced and nonfat milk; tofu made with calcium sulfate; fortified breakfast drinks; and calcium-fortified cereals. Vegetables that are the richest sources of calcium include turnip greens, kale, and Chinese cabbage. For those who are lactose-intolerant, eight ounces of calcium-fortified soy milk can have from 80 mg to 500 mg of calcium.  Rice and almond calcium-fortified beverages can be good sources of calcium, too. To find out how much calcium is in these drinks, check the nutrition label on the back of these products at the grocery store.

If you want to eat for bone health, there are also some foods you should avoid. Heavy alcohol drinking (more than two drinks per day) can lead to bone loss, as can drinking more than three cups of coffee per day. Drinks high in caffeine, including coffee, tea, and caffeinated soft drinks, decrease calcium absorption and contributes to bone loss. Sodas also make it harder for the body to absorb calcium. Salty foods cause your body to lose calcium, too. To reduce the sodium in your diet, limit processed foods, canned foods, and salt added to the foods you eat each day. Aim for 2,400 mg or fewer mg of sodium per day.

Although beans contain calcium, they also are high in substances called phytates that interfere with your ability to absorb calcium. To reduce the phytate level in beans, soak them in water for several hours and cook them in fresh water. Wheat bran also contain high levels of phytates, which prevent your body from absorbing calcium. The phytates in wheat bran not only prevent the absorption of calcium in wheat bran but also prevent the absorption of calcium in foods eaten at the same time. For example, if you have milk and 100 percent wheat bran cereal together, your body can absorb some, but not all, of the calcium from the milk. The wheat bran in other foods like breads, however, is much less concentrated and unlikely to have a noticeable impact on calcium absorption.

Some vegetables with calcium can also contain ingredients called oxalates. Oxalates make it more difficult for you to absorb the calcium in vegetables. Foods with both calcium and oxalates include spinach, rhubarb, and beet greens.

As you can see, getting the right kind of calcium and the right amount of calcium from foods are not a simple matter. Yet it’s well worth the effort, since it will improve your bone health and strength—and may reduce your need for supplements.

  1. Food and Your Bones. Fact sheet. National Osteoporosis Foundation.
  2. Dietary Supplement Fact Sheet: Calcium. National Institutes of Health.
  3. Calcium: An Important Nutrient that Builds Bones. Fact Sheet. Osteoporosis Canada.
  4. Calcium, Nutrition and Bone Health. Fact Sheet. American Academy of Orthopedic Surgeons. aaos.org.
  5. Rizzoli, R. Dairy products, yogurts and bone health. Am J Clin. 2014; 99 (suppl): 1256S-62S.