Healthy Lifestyle May Prevent 80% of Heart Attacks

Middle-aged and older men were much less likely to have heart attacks over an average of 11 years if they drank moderately, didn’t smoke, exercised regularly, ate right, and control their weight, a new study has found.

Only about 1% of the men involved in the study fit into this ultra-healthy-living category. But they were 86% less likely to have heart attacks than those who ate poorly, were overweight, exercised too little, smoked and drank too much alcohol, the researchers said.

The healthiest men could still eventually die of a heart attack, of course, and the study didn’t say if they live longer than others.

Still, “there is a lot to gain and money to be saved if people had a healthier lifestyle,” said study lead author Agnete Akesson, an associate professor with the Institute of Environmental Medicine at Karolinska Institute in Solna, Sweden.

For the study, published in the Journal of the American College of Cardiology, the researchers examined medical records and surveys of more than 20,700 Swedish men who were 45 to 79 years old in 1997. At the time, they had no history of cancer, heart disease, high blood pressure or high cholesterol. The researchers tracked them until 2009 to see how they fared.

8% of the men – 1,724 – did not practice any of the 5 healthy behaviors, and 166 of that group suffered heart attacks.

Of the 1% of men – 212- who practiced all 5 healthy behaviors, only 3 had heart attacks.
Based on their findings, the researchers concluded that all 5 healthy behaviors together could prevent 79% of first heart attacks in men.

Also, each behavior by itself reduced the risk for heart attack. For example, eating a diet rich in beneficial foods, such as fruits, vegetables, nuts, reduced-fat dairy and whole grains was associated with a nearly 20% lower risk compared to those who practiced none of the healthy behaviors, the study found.

Common Painkillers Tied to Blood Clot Risk, Study Suggests

People who use nonsteroidal anti-inflammatory drugs (NSAIDs) – which include aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin) – may be at increased risk for potentially deadly blood clots, a new study suggests.

But the study only showed an association between the use of NSAIDs and higher clotting risk, it did not prove cause-and-effect.

The researchers analyzed the results of six studies involving more than 21,000 cases of a type of blood clot called a venous thromboembolism (VTE). These clots include deep vein thrombosis (a clot in the leg) and pulmonary embolism ( a clot in the lungs).

Reporting in Rheumatology, the analysis found that people who used NSAIDs had an 80% higher risk for venous clots.

“Our results show a statistically significant increased VTE risk among NSAID users. Why NSAIDs may increase the risk of VTE is unclear,” said study lead author Palompoog Ungprasert, of the Bassett Medical Center, NY.

“Physicians should be aware of the association and NSAIDs should be prescribed with caution especially in patients already at a higher risk of VTE,” the researcher added.

Ungprasert stated that all types of NSAIDs were evaluated as a group, but not all NSAIDs may boost the risk of VTE.

Two experts said the findings are in keeping with prior research.

“It is not entirely surprising that NSAIDs are again implicated in causing clot related illness” said Dr. Steven Carsons, chief of the division of rheumatology, allergy and immunology at Winthrop University Hospital in New York. He pointed to the case of Vioxx, a powerful NSAID that was withdrawn from the market in 2004, after studies found a higher risk of heart attack and stroke in users.

The new study “makes a compelling case for further study and clinical surveillance for venous clotting events in those patients taking NSAIDs,” Carsons said. However, he stressed that the study could not pinpoint which types of NSAIDs might pose the greatest risk, or which type of patients might be most vulnerable.

Wisdom Wednesday: Chronic Low Back Pain

This new patient has been suffering from left sided sciatica for three months. About six weeks ago, he was hospitalized and treated for sciatica. During the hospital stay, he developed a perforated large intestine and had surgery, removing about a foot of large intestine and installing a colostomy bag. Subsequent surgery to remove the colostomy bag was successful. However, he developed C. difficile as a result of antibiotic therapy. After a few weeks, they were able to control the diarrhea well enough to send him home. He still has radiating pain down his left leg, his bowels are still inflamed with frequent diarrhea, and he now notes body wide aches.

Compare this history with the case of acute low back pain from last week’s Wisdom Wednesday. Obviously, this case is much more complex. On reviewing his history, he describes the pain as running down the anterior aspect of the left leg to the knee with occasional radiation into the groin. This is not the course of the sciatic nerve and, in fact, he was suffering from femoral neuralgia rather than sciatica. I have no clear information on the cause of the perforated intestine. However, I do comment on the relationship between these illnesses in my conclusions.

C. difficile kills about 1600 people in the US each year as the result of electrolyte imbalances associated with the diarrhea. It is an opportunistic infection that overgrows following the use of antibiotics. Please see my blog “Serious Diarrheal Infection in Kids Linked to Antibiotics” posted on March 14, 2014. Adults commonly develop C. difficile during hospital stays.

QA evaluation revealed impairment of Autogenic Facilitation (AF). Therapy Localization (TL) was to the surgical site of the perforated colon. This was corrected by Injury Recall Technique (IRT) restoring AF. Testing for inflammation was negative for prostaglandins, leukotrienes, cytokines, and histamine. However, nitric oxide was positive with a good response to L-glutamine, a particular probiotic (Saccharomyces boularidii), and folic acid. Challenge of the ilio-lumbar ligament was positive on the left, and after IRT correction, it returned again in weight bearing. TL was positive to the L4 vertebra, but no manipulation was performed.

Could Artificial Sweeteners Promote Diabetes and Obesity?

For those who are diabetic or dieting, you may think artificial sweeteners are your best friend.

They allow you to get the taste of sugar from foods and beverages without the elevated blood sugar levels or calories. But a new study suggests this may not be the case; artificial sweeteners could actually promote obesity and diabetes.

The research team, including Eran Elinav of the Department of Immunology at the Weizmann Institute of Science in Israel, recently published their findings in the journal Nature.

Because artificial sweeteners are low calorie and do not contain carbohydrates, they are often recommended to help with weight loss or to treat or prevent metabolic disorders, such as type 2 diabetes.

However, Elinav and colleagues note that, although some studies support such recommendations, others have indicated that artificial sweeteners actually increase weight gain and raise the risk of metabolic disorders. A study from the Washington University School of Medicine published last year claimed the artificial sweetener sucralose is linked to increased glucose and insulin levels.

“Despite the controversial data, the FDA approved six NAS (non-caloric artificial sweetener) products for use in the US,” the researchers note. These are saccharin, sucralose, aspartame, advantame, neotame and acesulfame potassium.

In this latest study, the team investigated how artificial sweeteners affected the metabolism of mice. For 11 weeks, some mice were supplied with drinking water supplemented with an artificial sweetener – either saccharin, sucralose or aspartame – and glucose, while others drank just water alone or water containing only sugar.

The team found that the mice that drank the water containing glucose and an artificial sweetener developed glucose intolerance – elevated blood sugar levels, whereas the mice that drank water alone or water containing only sugar did not.

Apple Watch Takes Tech Giant into New Territory

Apple unveiled a new product category – a smartwatch designed to provide consumers with a variety of technology services including comprehensive health and fitness apps to help them lead healthier lives.

Called Apple Watch and available in early 2015 starting at $349, the device includes an activity app designed to help motivate users to be more active, and a workout app that provides metrics during workout sessions. Billed as bringing together the capabilities of “an all-day fitness tracker and a highly advanced sports watch in one device,” Apple Watch uses an accelerometer, a built-in heart rate sensor, GPS and Wi-Fi from an iPhone to provide an overall picture of a person’s daily activity. (Photo via Apple.com)

The activity app measures three separate aspects of movement: calories burned, brisk activity and how often a user stands up during the course of a given day. The workout app allows users to set specific goals for popular session-based workouts, such as running and cycling. And, the companion fitness app on iPhone collects activity data to provide activity history in order to suggest personal foals, reward fitness milestones and motivate users.

“Apple Watch is the most personal device we’ve ever created,” said Tim Cook, Apple’s CEO. “Apple builds great products that enrich peoples’ lives and arguably we can take that to a whole new level with Apple Watch.”

At the same time, Cook said that Apple Watch “requires the iPhone because it’s been designed to seamlessly work together…This means that over 200 million people already can use Apple Watch.

However, Niharika Midha, medical device analyst at GlobalData, argues that the significant dependence of the health and fitness trackers on the iPhone’s Wi-Fi and GPS capabilities in comparison to other vendors is a drawback. For example, Midha said the Samsung Galaxy Gear S has a built-in GPS and can be used to tract activities without the phone.

Wisdom Wednesday: Acute Low Back Pain – A Brief Case History

This is the first in a series of typical case histories taken from my office notes. They will appear in the Wisdom Wednesday blog slot intermittently. I hope they will give the reader some insight into managing and guiding a patient through a health issue.

A 66-year old female returns to my office for the first time in six years with complaints of acute low back pain. She has been struggling with chronic bilateral knee pain and has had a couple of orthopedic opinions on treatment ranging from medication management to total joint replacement. She denies radiating pain from the back to the legs and believes the onset is related to compensating for the knee pain. She is currently on the following medications: Atenolol, Celexa, Benacar, Zyrtec, Eliquis, Prempro, Simustatin, Armour Thyroid, Flecainide and 2 baby aspirin per day. (The average American takes 4 prescription medications daily, so this patient is taking twice that amount. I commonly see patients taking 16 different prescription medications on a daily basis).

Autogenic Facilitation (AF) was intact, using a weak left gluteus medius as an indicator muscle. (This indicates no body wide injury response by the nervous system. Her body has either resolved the injury neurologically, or there was no body wide injury stimulation to begin with - the later fits her history) Oral challenge with a mix of NSAIDS resulted in strengthening of the weak muscle. A favorable response to oral challenge with fish oil was noted. (These tests indicate that her primary inflammatory response is the production of prostaglandins despite taking aspirin daily which tends to block this pathway) Challenge of the left ilio-lumbar ligament was positive in weight bearing only, corrected by Injury Recall Technique (IRT). (This is a local injury reflex and is the most common source of ongoing neurological stimulation in low back pain) Gait assessment was intact. (Despite her contention that this low back episode is the result of compensating for her knee pain, no altered gait mechanism was indicated)

A Deficiency of Nutrition Education in Medical Training

We do not need to wait for more studies on nutrition and health. Although additional research will add refinements to current knowledge, we need more action on what we already know.

A 2013 report on the state of US health identified dietary factors as the single most significant risk factor for disability and premature death. Despite the wealth of knowledge linking food and health, nutrition receives little attention in medical practice. The reason stems, in large part, form the severe deficiency of nutrition education at all levels of medical training to be described in this commentary.

The Lyon Mediterranean Diet Heart Study, published in 1999, showed a 72% reduction in cardiovascular events attributed to diet (an effect approximately twice that of most statin trials). A whole foods, plant-based diet low in refined carbohydrates and animal products has been proven to reverse coronary heart disease and confer potent protection against type 2 diabetes and cancer.

How has this knowledge affected medical education? A recent survey of medical schools revealed an average of fewer than 20 hours over 4 years devoted to nutrition education.