Bloomberg reported yesterday that the French drug agency is pulling pioglitazone from the market in view of its recent association with bladder cancer. I mentioned this here May 14. Pioglitazone is sold in the U.S. as Actos. I don’t expect the U.S. Food and Drug Administration to follow suit soon.
Exercise, Part 10: What If I’m Markedly Obese?
The more overweight you are, the harder it will be to exercise. At some point even light exercise becomes impossible. Average-height women tipping the scales at about 280 pounds (127 kg) and men at 360 pounds (164 kg) aren’t going to be able to jog around the block, much less run a marathon. These weights are 100 percent over ideal or healthy levels. An actual “exercise program” probably won’t be possible until some weight is lost simply through very-low-carb eating, calorie restriction, or bariatric surgery. The initial exercise goal for you may just be to get moving through activities of daily living and perhaps brief walks and calisthenics while sitting in a chair.
"I'll get started after I finish this cigarette."
If you’re markedly obese, several tricks will enhance your exercise success. I want you to avoid injury, frustration, and burn out. Start with light activity for only 10 or 15 minutes, gradually increase session length (e.g., by two to four minutes every two to four weeks) and increase exercise intensity only after several months. Your joints and muscles may appreciate easy, low-impact exercises such as stationary cycling, walking, swimming, and pool calisthenics/water aerobics. You may also benefit from the advice of a personal fitness trainer arranged through a health club, gym, or YMCA/YWCA. Check out several health clubs before you join. Some of them are primarily meat markets for beautiful slender yuppies. You may feel more comfortable in a gym that welcomes and caters to overweight people. Hospitals are increasingly developing fitness centers with obese orthopedic, heart, and diabetic patients in mind.
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Quote of the Day
The first flavor we experience in infancy is the sweet taste of milk. We learn to associate it with comfort, security and love. During childhood, we are offered sweet treats to cheer us up when we are sad, to reward us for being brave at a difficult time, or for being good when our parents need us to be. Thus, sugary food becomes a reward, an incentive or a token of love and is inextricably woven into our emotional fabric.
—Conner Middelmann-Whitney in Zest For Life: The Mediterranean Anti-Cancer Diet
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Dr. Robert Su Interviews Me
Ever wonder what I sound like?
Dr. Robert K. Su interviewed me for his podcast recently. That faint accent of mine is from Texas and Oklahoma.
Anyone with diabetes or prediabetes or worried about sugar toxicity is well-served by a close look at Dr. Su’s website, Carbohydrates Can Kill. Dr. Su has a degree in Pharmacy as well as a medical degree. He’s an anesthesiologist and pain managment specialist.
Filed under Shameless Self-Promotion
Egyptian Mummies with Atherosclerosis in the News Again
Remember about a year ago the report that hardening-of-the-arteries was found in Egyptian mummies? The heart arteries were also involved. Princess Ahmose-Meryet-Amon is officially the first person in history diagnosed with coronary heart disease.
This finding is noteworthy in view of the common view that atherosclerosis is a disease of modern civilization (usually referring to the last one or two hundred years).
You’ll find more details at this May 17 post at CardioBrief.
We’ll know more if these researchers ever publish their findings in a peer-reviewed scientific journal.
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Diabetic Drug Pioglitazone Linked to Bladder Cancer
A recent report in Diabetes Care (doi 10.2337/dc10-2412) suggests a link between pioglitzone and the development of bladder cancer. This is preliminary, not definitive proof. Further study may erase all concern about bladder cancer. The only other diabetic drug in this class (thiazolidinediones) is rosiglitazone: its use was just recently drastically reduced by the Food and Drug Administration.
Will pioglitazone eventually be pulled from the market because of this? How many will suffer from bladder cancer in the meantime? Nobody knows at this point.
We have 11 classes of drugs to treat diabetes. Would you believe we don’t know all the potential long-term adverse effects of most of these drugs? It’s true.
To me, that’s more reason to control diabetes with diet modification, such as the Low-Carb Mediterranean Diet or Dr. Bernstein’s Diabetes Solution.
Filed under Uncategorized
Penelope Cruz Touts Mediterranean Diet
Penelope Cruz credits the Mediterranean diet with helping her keep her weight under control, according to “The Times of India.”
Filed under Health Benefits, Mediterranean Diet, Weight Loss
R.I.P., Rosiglitazone
Rosiglitazone is pretty much dead. Here’s the eulogy at the FDA website. Rare is the doctor who will jump through all the paperwork hoops when we have 10 other classes of drugs to treat diabetes, plus another, safer drug in the thiazolidinedione class.
Rosiglitazone is linked to higher rates of heart disease and death.
Steve Parker, M.D.
.
Filed under Drugs for Diabetes
Recreational Activities Are Not Necessarily Exercise
Exercise is not supposed to be fun. If it is fun, then you should suspect that something is wrong.
The quote above is from an essay entitled “Exercise vs Recreation” by Ken Hutchins, posted at the Efficient Exercise website. Skyler Tanner works at Efficient Exercise and his blog is one that I follow. We have a strange connection. Skyler grew up in Fountain Hills, AZ; I live about 20 miles from there. He lives in Austin, TX, now; I lived there for eight years.
Here’s another quote from that essay:
One pound of human fat can support the energy demands of running 35-45 miles, probably more. This would require the average man to run for 6-8 hours. He would burn the calories he could easily ingest in as many minutes.
Hutchins’ essay is thought-provoking. It may change the way you think about exercise.
Filed under Exercise
Heart Patients: Mediterranean Diet to the Rescue!
The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010.
Reuters and other news services have covered the story.
The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes. Most of the studies in support of the heart-healthy diet looked at development of disease in general populations. The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.
How Was the Study Done?
The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009. In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris. Acute heart attacks and unstable angina are “acute coronary syndromes.” Average age was 64. Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke). Thirty percent had diabetes. At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function. Men totalled 788; women 212.
On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year. If a potential enrollee died in the first two hospital days, he was not included in the study. A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet. Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol.
Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge. Systolic dysfunction was defined as an ejection fraction of under 40%. [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]
Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function.
They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.
Results
- Four percent of participants died during the initial hospitalization.
- At the three month follow-up visit, those with greater adherence to the Mediterranean diet (a high Mediterranean diet score) had higher left ventricular performance (P=0.02).
- At the time of hospital admission, higher ejection fractions were associated with greater adherence to the Mediterranean diet (P<0.001).
- Those who developed diminished left ventricular dysfunction had a lower Mediterranean diet score (P<0.001)
- During the hospital stay, those in the highest third of Mediterranean diet score had lower in-hospital deaths (compared with the lower third scores) (P=0.009).
- Among those who survived the initial hospitalization, there was no differences in fatal cardiovascular outcomes based on Mediterranean diet score.
- Food-specific analysis tended to favor better cardiovascular health (at two-year follow-up) for those with higher “vegetable and salad” and nut consumption. No significant effect was found for other components of the Mediterranean diet score.
- Of those in the highest third of Mediterranean adherence, 75% had avoided additional fatal and nonfatal cardiovasclar disease events as measured at two years. Of those in the lowest third of Mediterranean diet score, only 53% avoided additional cardiovascular disease events.
The Authors’ Conclusion
Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.
My Comments
I agree with the authors’ conclusion.
We’re assuming these patients didn’t change their way of eating after the initial hospitalization. We don’t know that. No information is given regarding dietary instruction of these patients while they were hospitalized. In the U.S., such instruction is usually given, and it varies quite a bit.
In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay. Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years. Mysteriously, the authors don’t bother to discuss this finding.
For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without alcohol. A 2009 study by Trichopoulou et al suggests otherwise.
Reference: Chrysohoou, C., et al. The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event. American Journal of Clinical Nutrition 2010. DOI: 10.3945/ajcn.2009.28982
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Filed under Alcohol, coronary heart disease, Health Benefits, Mediterranean Diet
Diabetic Mediterranean Diet 