Wood Street Clinic Blog

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Taller people less likely to develop type 2 diabetes

New research from Germany has found that taller people have a lower risk of type 2 diabetes.
people of different ages texting
Height may influence people's diabetes risk, new research suggests.

For every 10 centimeters (cms) of additional height, there was a 41% reduced risk of type 2 diabetes in males and 33% in females, according to the recent Diabetologia study.

The researchers had adjusted the results to remove the potential effects of age, education, lifestyle, and waist size on diabetes risk.

They suggest that the inverse relationship between height and type 2 diabetes risk could be due to less fat buildup in the liver and more favorable cardiometabolic risk factors, "specifically blood fats, adiponectin, and C-reactive protein."

Among those with a body mass index (BMI) in the overweight or obese range, the risk of type 2 diabetes reduced by 36% in males and 30% in females for every additional 10 cm of height.

"This may indicate," write the authors, "that a higher diabetes risk with larger waist circumference counteracts beneficial effects related to height, irrespective of whether larger waist circumference is due to growth or due to an energy imbalance."

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Short stature and type 2 diabetes link

The study is the work of scientists from the German Center for Diabetes Research and the German Institute of Human Nutrition Potsdam-Rehbruecke, both in Germany.

The researchers drew on records relating to 27,548 participants who enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) study at Potsdam in Germany during 1994–1998.

Of these participants, 16,644 were female and aged 35–65 years and 10,904 were males from 40–65 years of age. For their analysis, the researchers randomly selected a representative sample of around 10% of the cohort.

The new findings follow those of previous research that also linked short stature with a higher risk of type 2 diabetes.

Reports that taller people may have greater insulin sensitivity and better functioning beta cells have accompanied these earlier findings.

Those studies also found links between shorter stature and raised risk of cardiovascular conditions. Such relationships could involve risk factors with ties to type 2 diabetes — including elevated blood pressure, inflammation, and blood fats.

Such findings would suggest that height might serve to predict the risk of type 2 diabetes.

Leg length and sitting height

The new study, however, sought not only to examine the relationship between height and type 2 diabetes but also to look more closely at two components of height: leg length and sitting height.

The team found that for males, there was a strong connection between longer leg length and lower risk of type 2 diabetes. In females, however, both sitting height and leg length contributed to this effect.

These findings would suggest, note the authors, that growth before puberty has a more significant effect on lower diabetes risk than growth after puberty in males. They explain that they base this on the assumption that leg bones stop growing before trunk bones.

For females, however, it appears that both growth before and after puberty contribute to lower diabetes risk.

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Liver fat and cardiometabolic profile

Among their analyses, the researchers calculated the extent to which liver fat and other cardiometabolic risk factors might explain the relationship between height and type 2 diabetes.

They found that when they took out the potential effect of liver fat content, the reduction in type 2 diabetes risk per 10 cm of extra height in males was 34% (compared with 41% in total) and 13% in females (compared with 33% in total).

Certain cardiometabolic risk factors also had an effect. In males and females, both blood fats and glycated hemoglobin (a blood sugar measure) appeared to influence the relationship between height and type 2 diabetes.

In females, however, there were additional impacts from adiponectin and C-reactive protein. Adiponectin is a hormone that affects control of blood sugar, and C-reactive protein is a marker of inflammation.

Bringing these results together, the researchers suggest that much of the favorable effect that greater height has on reduced risk of type 2 diabetes likely comes from taller people having lower liver fat content and more favorable cardiometabolic risk profiles.

They comment that their findings point to a need to include cardiometabolic profile, alongside height, as a useful predictor for diabetes risk.

They advise that doctors should perhaps monitor cardiometabolic risk more often in people of shorter stature, even if their body size and composition might indicate otherwise.

The authors conclude:

"Our study also suggests that early interventions to reduce height related metabolic risk throughout life likely need to focus on determinants of growth in sensitive periods during pregnancy, early childhood, puberty, and early adulthood, and should take potential sex differences into account."
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Daytime napping 1–2 times a week may benefit heart health

Taking a daytime nap once or twice a week may halve the risk of cardiovascular events, such as heart attacks, strokes, and heart failure.
woman napping in hammock
New research suggests that napping during the day could protect heart health, after all.

This is the main takeaway of an observational study appearing in the BMJ journal Heart.

Nadine Häusler, Ph.D., from the department of internal medicine at Lausanne University Hospital, in Switzerland, is the first author of the study.

As Häusler and colleagues explain in their paper, much controversy has surrounded the relationship between daytime napping and cardiovascular health.

Some previous studies, referenced by the authors, have found a lower risk of coronary heart disease among daytime nappers, while others have found a higher risk of cardiac events or cardiovascular mortality among those who regularly nap during the day.

To help settle the controversy, Häusler and the team set out to examine the link between napping and fatal and nonfatal cardiovascular events in a cohort of 3,462 adults in Switzerland.

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Studying naps and cardiovascular events

Häusler and colleagues had access to medical data from participants in the CoLaus cohort study.

The participants were between 35 and 75 years of age when they enrolled in the CoLaus study and did not have a history of cardiovascular problems at baseline, that is, in 2003–2006.

The researchers looked at the associations between napping frequency and napping duration, on the one hand, and the incidence of heart attacks, strokes, and heart failure, on the other.

Häusler and the team had access to self-reported sleeping patterns and continual health monitoring over an average period of 5 years, as part of the CoLaus study.

When the participants were asked about their sleeping and napping patterns, more than half reported no naps in the previous week, almost 20% said they had napped once or twice, about 12% said they had napped 3–5 times, and a similar number said they had napped 6–7 times.

Those who napped more frequently tended to be older, overweight males who smoked. These participants also tended to sleep for longer at night, have sleep apnea, and feel more sleepy during the day.

Naps tied to 48% lower cardiovascular risk

During the 5-year monitoring period, 155 cardiovascular events occurred. To assess the association between naps and cardiovascular events, the researchers accounted for potential confounders, such as age or heart disease risk factors, such as hypertension.

The researchers found that taking 1–2 weekly naps during the day was linked with 48% lower chances of having a heart attack, stroke, or heart failure, compared with those who did not nap at all.

However, the analysis revealed no link between cardiovascular events and the duration of the naps.

Häusler and colleagues conclude, "Subjects who nap once or twice per week have a lower risk of incident [cardiovascular disease] events, while no association was found for more frequent napping or napping duration."

"Nap frequency may help explain the discrepant findings regarding the association between napping and [cardiovascular disease] events."

Yue Leng, Ph.D., and Dr. Kristine Yaffe, of the University of California, San Francisco, independently comment on the findings in a linked editorial.

They say that it is "premature to conclude on the appropriateness of napping for maintaining optimal heart health," given that we lack a standard definition or measurement of naps.

However, they add, "While the exact physiological pathways linking daytime napping to [cardiovascular disease] risk is not clear, [this research] contributes to the ongoing debate on the health implications of napping and suggests that it might not only be the duration, but also the frequency that matters."

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What do code blue and other hospital codes mean?

Hospital intercoms sometimes blare unfamiliar codes and alerts that may be confusing to patients. Each hospital code refers to a specific emergency situation.

Code blue means that there is an urgent medical emergency. This is usually a patient in cardiac or respiratory arrest. Other codes denote other emergencies, such as an active shooter or hazardous waste spill.

Hospital codes are a quick way to tell hospital workers who needs to attend to an emergency situation, what they need to bring, and what they should expect.

Hospital staff should consult their manual for details about their hospital's codes, since practices can vary from facility to facility.

In this article, learn all about the meanings of different hospital codes and their benefits.

Code blue some medical professionals responding to a Code blue in a hospital
A code blue is a quick way to tell staff that someone is experiencing a life threatening medical emergency.

Code blue means that someone is experiencing a life threatening medical emergency. Usually, this means cardiac arrest (when the heart stops) or respiratory arrest (when breathing stops).

All staff members near the location of the code may need to go to the patient.

In most cases, each medical provider will have a preassigned role in the event of a code blue during their shift.

Code white In previous years, code white had the same meaning as code blue, but it specifically referred to medical emergencies in children and babies. Some hospitals may still use code white instead of code blue for pediatric medical emergencies. For example, some hospitals may still use code white to alert staff that a child or baby is in respiratory or cardiac arrest, or to signal that they are experiencing another serious medical emergency. Treating children sometimes requires smaller or specialized equipment, or even different medical procedures. Having a different code for a pediatric emergency alerts staff to these unique needs. Other hospitals now use code white to indicate a mandatory evacuation. This could involve the entire hospital, or it may involve just one or two areas of the hospital. Thank you for supporting Medical News Today Code red Code red alerts staff to a fire or probable fire. To respond to this code, staff must follow the hospital's fire protocols, which typically require evacuation. Patients near the fire who cannot move on their own will need assistance to escape the fire. The code will often come with information about the fire's location. Code purple or pink Code purple alerts hospital staff to a missing child or child abduction. Some hospitals use a separate code, code pink, to denote an infant abduction. The code should also include clear details about the child, what they were wearing, where they were last seen, and, if applicable, clear details of who they were last seen with. In most cases, the hospital will go on lockdown during the search for the child. This is to ensure that nobody leaves the building with them. Code gray At some hospitals, code gray is a call for security personnel. It might indicate that there is a dangerous person in a public area, that a person is missing, or that there is criminal activity somewhere in the hospital. A hospital may use code gray if someone, including a patient, is being aggressive, abusive, violent, or displaying threatening behavior. Security personal can assist other hospital staff to resolve the situation or remove the person from the premise if necessary. Code gray may also include a description of the dangerous person and their current location. Code green Paramedics taking patient on stretcher from ambulance to hospital
A code green may indicate the arrival of patients from a mass casualty event. Hospitals tend to use code green along with other codes, as it indicates that the hospital is activating an emergency operations plan. Some hospitals also use a code green to denote a mass casualty event, such as groups of survivors of a mass shooting arriving at the hospital for treatment. The code may include a description of the mass casualty scenario, as well as information about which emergency operations plan that code activates. Code orange Code orange is a call for medical decontamination, usually due to a hazardous fluids spill. For example, a hospital may call a code orange if toxic chemicals spill in an emergency room, or if a bag of patient blood spills on the floor. However, some hospitals use code orange to call for help with a violent or combative patient. Code silver Code silver alerts hospital staff to an active shooter in the hospital. The code alert will likely include information about the appearance and current location of the shooter. Hospital personnel should follow the hospital's active shooter protocols, which may include locking doors or evacuating to a specific location. Some hospitals use code silver and code gray interchangeably. However, the Joint Commission — whose recommendations the United States Department of Health and Human Services and the U.S. Department of Homeland Security support — updated its standards in 2010 to recommend the use of code silver as a distinct code from code gray. However, in 2014, the Recommendations for Hospital Overhead Emergency Codes — by the Florida Hospital Association — advised using plain language instead of a code for an active shooter situation and using code gray specifically to announce the need for security personnel. This is because announcing the presence and location of an active shooter in the building, rather than using an emergency code, can help ensure that more people understand the situation and can take the relevant safety precautions. Thank you for supporting Medical News Today Code black Code black indicates a bomb threat. The code tends to include relevant information, such as the specific location of the threat. If there is a person in the hospital threatening to bomb the building, the code may also include a description of the person. More specific threats are more credible. So, people who receive bomb threats over the phone should remain calm and gather as much information regarding the purported bomber as possible. Each hospital will have an evacuation protocol in the event of a bomb threat. Benefits and drawbacks The inside of a hospital.
Hospital codes can quickly and succinctly provide key information to medical staff. Hospital overhead codes standardize a hospital's response to various emergencies. This allows them to quickly get the attention of staff and others. Some other benefits of hospital codes include: succinctly providing key information about an emergency without wasting time the ability to devise a specific plan for each code a uniform and preplanned response to various emergencies in some cases, the ability to alert staff to a serious problem without triggering panic in patients Every hospital adopts a slightly different approach to codes, however, which can be a problem when a staff member works at multiple facilities or moves from one facility to another. Many hospitals and healthcare facilities in the same area try to standardize their codes. Some other drawbacks of hospital codes include: a reduced ability to alert patients to an emergency that requires their response difficulty coordinating an emergency response across teams the risk that staff may panic when they hear a code Summary Hospital codes are a simple way to alert staff to an actual or potential emergency. Codes help healthcare providers effectively respond to their patients' needs. Patients may find these codes confusing, but they should feel assured that each staff member knows what to do during each situation. It is important to note that some hospitals use different codes than others. Codes will likely remain a part of hospital culture because of their ease of use. Patients and hospital staff who want to better understand the codes in use at their hospital should consult a manual or ask about the hospital's emergency management plan.
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Keto and paleo diets: What are the differences?

The keto and paleo diets are among the most popular diets today. They share some similarities, but there are also differences in the foods they allow, their effects on the body, and key health effects.

The ketogenic (keto) diet focuses on eating a particular balance of macronutrients. The goal is to enter a state of ketosis, where the body begins to burn fat for health or weight loss.

The Paleolithic (paleo) diet focuses on eating foods that humans would have eaten in the Stone Age. The goal is to eliminate modern processed foods for health or weight loss.

This article looks at the similarities and differences between the keto and paleo diets, including their benefits, food lists, and side effects.

What are keto and paleo diets? The keto and paleo diets are two dietary options that aim to boost health, eliminate highly processed foods, and encourage weight loss. The following sections provide an overview of keto and paleo diets: Keto diet a man looking in his fridge wondering the benefits of keto vs paleo
Both keto and paleo diets can boost health and encourage weight loss.

A keto diet is an eating plan that focuses on eating lots of healthful fat, some protein, and minimal carbohydrates.

The body typically uses carbohydrates as fuel for energy. When a person does not get enough carbs, the body will start using up fat and some protein stores. In true ketosis, the liver will take stored fat and turn it into ketones, which the body then uses for energy. Reaching this state of ketosis is the goal of the keto diet.

Some believe ketosis is an efficient way to lose excess fat and to reduce the risk of problems, such as heart disease and diabetes.

In general, a person on a keto diet should consume:

70–80% fat 20–25% protein 5–10% carbohydrates

The keto diet encourages and excludes specific foods. A person on keto cannot get their carbohydrates from grains or legumes. Their carbs must come from a keto friendly vegetable, such as leafy greens, or a small group of fruits, primarily berries.

Read about the potential benefits and risks of a keto diet here.

Paleo diet

A paleo diet is a dietary plan that focuses on foods that humans ate during the Paleolithic era. Some people refer to it as the caveman diet or the Stone Age diet.

This diet strives to eliminate products made via modern food processing and farming methods. People who follow the paleo diet may choose foods that a Stone Age ancestor would have been able to hunt or gather and eat. The diet of a Stone Age person would have varied according to the natural resources available in their area.

Some people believe that the human body is not well adapted to modern-day foods. According to supporters of the diet, cutting out foods such as dairy, grains, and legumes can help a person lose weight and prevent heart disease and diabetes.

A paleo diet excludes highly processed foods, as well as legumes, grains, and dairy products.

The paleo diet also encourages the consumption of healthful fats, such as those from wild or grass-fed animals, nut oils, butter, olive oil, and avocados. It also recommends that people eat higher amounts of animal protein.

According to some small, short term studies, the paleo diet may have benefits for metabolic syndrome and improving cholesterol levels. However, scientists need to carry out more research to confirm this.

an infographics showing the difference and similarities between a keto and paleo diet
Thank you for supporting Medical News Today Similarities between the keto and paleo diets Both diets encourage the consumption of many nutritious whole foods and exclude highly processed foods. Both involve a low carb intake and do not allow the consumption of grains and legumes. They emphasize meat for protein and recommend certain types of fats and vegetables. Both paleo and keto diets include: nuts seeds unprocessed meat seafood eggs healthful fats, such as olive oil, avocado oil, and nut oils non-starchy vegetables Exclusion of highly processed foods Both keto and paleo diets exclude many unhealthful foods, including: processed foods, such as chips, crackers, and packaged snacks foods that contain white or brown sugar, corn syrup, or agave nectar Exclusion of healthful foods Both diets exclude a variety of foods that many people would consider healthful. In fact, the 2015-2020 Dietary Guidelines for Americans lists some of these foods. They include: whole grains, including rice, wheat, quinoa, pasta, bread, and oats legumes, including beans, peanuts, peas, soy, and lentils These two diets encourage lower carbohydrate intake than the traditional reduced calorie or low fat weight loss plans that experts have recommended for years. For instance, the National Institutes of Health (NIH) and American Heart Association recommend a daily intake of whole grains, which are not a part of keto and paleo plans. What are the differences between keto and paleo diets? The keto and paleo diets exclude different foods. The keto diet excludes high sugar foods, including most fruits, while the paleo diet allows more fruits and some natural sweeteners. They also have different rules for meats, vegetables, and dairy. The following sections look into key differences between the keto and paleo diets. Processed meat A paleo diet usually excludes processed meats, such as bacon, salami, and ham, as these are the result of modern food processing techniques. Some people believe that minimally processed bacon without nitrates or preservatives is acceptable on the paleo diet, while others do not. The keto diet allows these types of meat as long as they do not contain sugar or carbohydrates, which could interfere with the body's ability to reach ketosis. Some processed meats, such as bacon or sausage, may contain sugar, so people need to read the labels. However, with research indicating that processed meats may increase the risk of cancer and other health issues, people on any diet may wish to focus on eating good quality meats rather than processed ones. Paleo: Focuses on natural and grass-fed, no processed meat. Keto: Allows any meat that does not contain added sugar or carbohydrates. Sweeteners and sugar The paleo diet allows some "natural" sweeteners, such as honey and maple syrup. But, it does not allow artificial sweetener, including sugar alcohols, because they are a result of modern technology. The keto diet allows some artificial sweeteners as long as they do not contain any sugar (some products contain both sugar and artificial sweeteners). Ideally, a person should choose sweeteners that do not cause spikes in blood sugar, such as stevia and sucralose. The keto diet does not allow honey, maple syrup, or other products that contain natural sugar or fructose. Paleo: Allows raw honey, maple syrup, date sugar, and coconut sugar. Keto: Does not allow any sugars, but allows some artificial sweeteners, such as stevia and sucralose. Starchy vegetables Some nutrient rich vegetables also have a high starch or carbohydrate content. These "starchy vegetables" are not allowed on the keto diet because they could interrupt ketosis and cause a person to consume more than their allotted total of carbohydrates. However, the paleo diet allows many of these nutritious vegetables in moderation. A person following the paleo diet can eat foods such as sweet potatoes, beets, and carrots in moderation, but should prioritize lower carb vegetables. Read about low carb fruits and vegetables here. Fruit Fruits contain a range of nutrients, vitamins, minerals, fiber, and antioxidants, and are a healthful choice for most people. However, fruits also contain some natural sugar, and some have higher levels of sugar and carbohydrates than others. A person following a paleo diet can eat all fruits, including fresh, dried, and frozen, but they should generally focus on lower sugar types. A paleo diet includes plenty of berries, citrus fruits, and melons. It can include sweeter fruits, such as bananas, grapes, mangoes, and cherries, but ideally, in lower amounts. The keto diet is more strict with fruit. It advises that to keep the body in a state of ketosis, a person should only eat lower sugar fruits, and only in small amounts. Berries are a common keto friendly fruit, but a person may also eat small amounts of cranberries, peaches, apricots, apples, and plums. Paleo: Allows all fruits, though higher sugar ones in moderation. Keto: Allows only lower sugar fruits. Dairy The paleo diet excludes all dairy products because Paleolithic humans did not consume them. The paleo diet does not allow a person to consume cheese, milk, cream, or other dairy products. However, people on the paleo diet can drink unsweetened nut milk, coconut milk, and similar alternatives that do not contain artificial sweeteners or thickeners. The keto diet allows some dairy products, especially those that are higher in fat and protein. This allows the person to take in the recommended amounts of these nutrients. The keto diet does not include any dairy products that may contain sugar, such as ice cream, chocolate milk, or sugar-sweetened coffee creamer. However, a person may consume dairy products that contain artificial sweeteners in moderation. Paleo: Excludes dairy products. Keto: Allows dairy without sugar, ideally higher fat and higher protein types. Side effects People following any diet that eliminates food groups should make sure they are meeting their daily nutrient requirements to avoid deficiencies. Anyone considering making a new and drastic change to their eating pattern should check in with their healthcare provider first. This is especially important for people who have chronic health conditions, such as heart disease, diabetes, or high blood pressure. People following the keto diet may experience side effects related to entering a state of ketosis. These include keto breath, a keto skin rash, and the "keto flu." Symptoms off the keto flu include headaches, lethargy, nausea, mental slowness, insomnia, decreased exercise performance, constipation, and low libido. It can be harmful to stay in a state of ketosis for extended periods. People do not experience these symptoms with paleo diets, as paleo diets do not lead to a state of ketosis. Certain nutritional supplements can help people following the keto diet to get enough nutrients, ease side effects, and meet their daily macronutrient goals. Read about 7 supplements for the keto diet here. One article cautions people who follow the paleo diet to make sure they are getting adequate calcium since the diet excludes dairy products. The keto diet lacks fiber and several micronutrients due to the severe restriction of foods that contain carbohydrates. Food lists The following sections provide a list of foods that a person can eat when following the keto or paleo diet. Keto diet Common foods that people eat when following the keto diet include: fatty fish, such as salmon, tuna, or sardines shellfish, including mussels, clams, or oysters poultry fatty cuts of meat game meat non-starchy vegetables, such as leafy greens, cruciferous vegetables, asparagus, olives, bell peppers, celery, and squash mushrooms plain Greek yogurt with no sugar or fruit plain cottage cheese avocados eggs, especially egg yolks healthful oils, such as olive oil, nut oils, and avocado oil nuts, including macadamia nuts, pistachios, peanuts, walnuts, and almonds seeds, including chia seeds and flaxseed butter, ghee, or cream coconut or cocoa butter dark chocolate with at least 70% cocoa solids and very little to no sugar added nut butters, including almond butter, that contain no added sugar cheese berries, including raspberries, blueberries, strawberries, and blackberries lemons and limes tomatoes bone broth unsweetened tea and coffee Paleo diet cut avocados being eaten with a spoon
People following the paleo diet can eat avocado. Common foods that people eat when following the paleo diet include: chicken turkey eggs seafood pork beef game meat vegetables, especially leafy greens, celery, asparagus, peppers, and cruciferous vegetables small-to-moderate amounts of starchy vegetables, such as potatoes and root vegetables fruit, emphasizing berries, tomatoes, citrus, and other lower sugar fruits avocado small or moderate amounts of higher sugar fruits, such as grapes and bananas nuts seeds nut butter cocoa butter dark chocolate with at least 70% cocoa coffee with no dairy cream or refined sugar teas healthful oils, including nut oils, olive oil, and avocado oil honey, maple syrup, and coconut sugar in small amounts Thank you for supporting Medical News Today Summary Both the keto and paleo diets have specific guidelines that include and exclude certain types of food. There are some similarities but plenty of variation between the diets. Both may have health benefits related to eliminating highly processed foods, which may help with weight loss. For most people, these diets require a drastic shift from previous eating habits. Some people may find eliminating all grains and legumes and increasing fat content difficult to sustain long term. People following these diets must also make sure they still meet their nutritional requirements. A person should base their decision to follow either of these diets on their current health condition, how strict they want to be with their diet, and their individual health goals. Some people following the paleo diet will eat processed foods as long as they are low sugar, contain no dairy or grains, and are paleo friendly. Others on the paleo diet may eat only foods in their natural state, excluding anything that comes in a package. Some people on the keto diet eat any meat, as long as it is carb free. Others focus on grass-fed and healthful meats only. People will benefit from speaking with their doctor before changing their diet, especially if they have diabetes, heart disease, or other health conditions.
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Vegetarian heart health: Study identifies benefits and risks

The authors of a large, long term study conclude that pescatarianism and vegetarianism have an association with a reduced risk of ischemic heart disease, but they note that vegetarians have a slightly higher risk of stroke.
Cutting vegetables
A new, large scale study places the health effects of vegetarianism under the microscope once again.

Over recent years, increasing numbers of people have decided to reduce the amount of meat in their diet.

Vegetarians, vegans, and pescatarians (people who eat fish but not meat) are a growing demographic.

Following any one of these meat-free diets is nothing new, but due to the spike in popularity, researchers are keen to understand the possible health implications.

A recent study, which features in BMJ, looks specifically at plant based diets and their effect on the risk of stroke and ischemic heart disease (IHD).

IHD refers to any problems that occur due to a narrowing of the arteries to the heart. Without treatment, it can lead to a heart attack.

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What do we already know?

Earlier studies have concluded that vegetarians have a lower risk of obesity and IHD, but as a review of relevant research explains, there is a need for more long term studies involving larger numbers of people.

As for stroke risk, only a few studies have looked into the relationship between a plant based diet and stroke risk. According to the authors of the current study, these "found no significant differences in risk of total stroke deaths between vegetarians and nonvegetarians."

The latest study aimed to fill in some of these gaps. In all, the scientists took data from 48,188 people whom they followed for an average of 18.1 years.

The participants, who had an average age of 45 years at the start of the study, had no history of IHD or stroke.

The researchers assigned each participant to one of three groups:

Meat eaters: people who reported eating meat Fish eaters: those who ate fish but no meat Vegetarians and vegans: people who did not eat meat or fish

The team combined vegans with vegetarians for the main analysis due to the small number of vegans in the dataset.

Using food questionnaires, the researchers could also assess overall food intake and nutrient levels. Aside from dietary information, they collected information about factors such as body mass index (BMI), height, and blood pressure.

A double edged sword

During the 18.1 years of follow-up, there were 2,820 cases of IHD and 1,072 cases of stroke.

After adjusting for sociodemographic and lifestyle factors, the analysis revealed both positive and negative relationships between cardiovascular health and reduced meat intake.

The rate of IHD among pescatarians was 13% lower than that of meat eaters, while vegetarians had a rate that was 22% lower. To put these numbers into perspective, the authors explain:

"This difference was equivalent to 10 fewer cases of ischemic heart disease [...] in vegetarians than in meat eaters per 1,000 population over 10 years."

According to the authors, this positive association appears to be, at least partly, due to lower rates of hypertension and diabetes, as well as lower BMI and cholesterol levels. However, even after the scientists had adjusted the data to account for these factors, the effect was still "marginally significant."

Conversely, vegetarians had 20% higher rates of stroke than meat eaters. This difference is equivalent to three more cases of stroke per 1,000 people over 10 years. This association was mostly due to hemorrhagic stroke rather than ischemic stroke.

No previous studies have shown this type of relationship between vegetarianism and stroke risk. The authors believe that this might be because earlier work reported stroke mortality rather than incidence. Strokes are only fatal in 10–20% of cases, so many cases would not count toward the reported total.

Why the scientists saw this increase in stroke risk is up for debate. The authors believe that it might be due to lower levels of other circulating nutrients in the blood of vegetarians. These might include essential amino acids and vitamins B-12 and D.

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Strengths, limitations, and further work

The study has a number of strengths; first and foremost, the researchers used a large sample size and a long follow-up period. They also linked participants to their medical records to ensure the accurate collection of health outcomes.

In addition, the researchers checked the participants' eating habits at two time points that were years apart, finding that adherence was good overall.

However, there were certain limitations. For instance, the participants self-reported their diet, which leaves room for error and misreporting. Diet can also fluctuate over days, weeks, and years.

Also, researchers did not have access to the use of drugs, including statins, among participants.

As the study is observational, it is not possible to conclude that the effect is causal. In other words, the changes in risk could be due to other factors that the scientists did not measure.

Lastly, because the participants were predominantly European and white, the findings may not be widely applicable.

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An editorial by Prof. Mark A. Lawrence and Prof. Sarah A. McNaughton from Deakin University in Australia accompanies the paper.

In it, the authors call for caution, explaining how the conclusions are "based on results from just one study, and the increase is modest relative to meat eaters."

They also explain that studies "have reported mostly protective associations between vegetarian diets and chronic disease risk factors."

These results are sure to open debate and spark more research. That vegetarianism protects against IHD is not surprising given past findings. However, the fact that giving up meat might slightly increase stroke risk is unexpected. More work is sure to follow.

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Physical inactivity for 2 decades linked with twice the mortality risk

Experts have long associated sedentary lifestyles with poor health outcomes, but a recent study was a little more specific. It found that those who had led a physically inactive life for at least 20 years had a twofold greater risk of premature death when compared with physically active people.
senior couple watching tv on the sofa
New research suggests that 2 decades of sedentarism may double the risk of premature death.

The researchers presented their findings at the European Society of Cardiology (ECS) Congress 2019, which took place in Paris, France.

The researchers looked at how physical activity over 22 years was linked to death in general, and more specifically, death from cardiovascular disease.

In prior studies, researchers evaluated physical activity and its effects on mortality in a different way. These earlier studies typically involved researchers asking participants about exercise habits once and then following them for a few years.

In this study, the researchers included how physical activity habits and behaviors change over time. They wanted to look deeper at the connection between physical activity over a long timespan and how it tied into mortality rates.

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Evaluating physical activity in the long run

This recent study, led by Dr. Trine Moholdt of the Norwegian University of Science and Technology, in Trondheim, Norway, used information from the HUNT study. The Hunt study recruited Norwegian residents aged 20 or over, and checked up on their physical activity over three different periods: 1984–1986, 1995–1997, and 2006–2008.

At each follow-up, researchers asked participants about the frequency and duration of both leisure time and physical activity. This current study used data from the first and third surveys and included extra statistics on death up to 2013

The researchers established a reference group that consisted of people who reported a high level of exercise during the first and third periods for comparison purposes.

The researchers compared the high exercise group with those who were not physically active in both 1984–1986 and 2006–2008. They found that those in the low activity group were twice as likely to die from all causes and had a nearly threefold greater risk of death due to cardiovascular disease.

Ways to reduce cardiovascular risk

Dr. Moholdt notes that there is a range of recommendations about how much exercise an adult should do. For example, the American Heart Association (AHA) state that regular exercise can help reduce a person's chances of developing cardiovascular disease.

Their current recommendation is for people to aim for at least 150 minutes of moderate-intensity exercise every week. This can include brisk walking, swimming, dancing, or cycling.

They also note that even if someone is not very active, doing a little bit of exercise here and there can have cardiovascular benefits.

The AHA say that only about 50% of adults in the United States get adequate exercise. They also add that sitting down for prolonged periods can compound the problem and negate some of the benefits of physical activity.

Other heart-healthy habits include eating more fruits, vegetables, legumes, nuts, whole grains, and fish while limiting salt, saturated fats, processed meats, and fried foods. They also recommend avoiding tobacco and setting a goal to achieve — and keep — a healthy weight.

Even small, later changes make a difference

Another important finding from the study indicates that making even small changes can lead to improved health, notes Dr. Moholdt.

"Physical fitness is more important than the amount of exercise. Clinicians should individualize their advice and help people do even smaller amounts of activity that will improve fitness — this includes all types of exercise that make you breathe heavily."

Dr. Trine Moholdt

She explains that their data show that even for those who were previously inactive, making changes later in life can have benefits. Exercise may not only guard against premature death, but it can also help keep the body's organs and cognitive function in good shape.

"Physical activity helps us live longer and better lives," she says.

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What is the rarest blood type?

The rarest blood type is Rhnull. Unlike other blood types, people with Rhnull blood have no antigens on their red blood cells.

Researchers estimate that just 1 in 6 million people have Rhnull blood.

Healthcare professionals classify blood type according to the presence or absence of antigens, which are proteins attached to red blood cells.

In this article, learn more about the rarest blood type. We also cover other blood types, including whether or not they are compatible with each other.

Rare blood types Blood types sample held in beaker by gloved hand
Rhnull is the rarest blood type.

The American Red Cross define a blood type as "rare" when it occurs in fewer than 1 in 1,000 people. Rhnull is the rarest of these.

Having a rare blood type can make it difficult or even impossible to get a blood transfusion or organ transplant.

It can also cause other health issues. For example, if their blood is incompatible with a developing fetus, pregnant women with rare blood types may experience complications. One Iranian woman with Rhnull blood had several pregnancy losses.

Most blood types fall into one of four blood type groups, according to whether they contain A or B antigens.

For example, people with A antigens have type A blood, while those with B antigens have type B blood. People with both A and B antigens have type AB blood, while people with neither antigen on their red blood cells have type O blood.

In addition to the blood group type, a person may also carry Rh factor on their red blood cells. A person without Rh factor has Rh- blood, while someone with it has Rh+ blood. For example, a person with AB blood and Rh factor has AB+ blood.

Some people, including those with Rhnull blood, lack one or more common antigens. There are more than 30 other known blood groups and more than 600 antigens.

Thank you for supporting Medical News Today Other types Although most people have blood that falls into one of four blood group types, these types vary in prevalence across ethnic groups and geographic regions. According to data from the Stanford School of Medicine Blood Center, AB- blood is the rarest type in the United States. Just 0.6% of people in the U.S. have this blood type. The prevalence of the other common blood types in the U.S. is as follows: O+: 37.4% O-: 6.6% A+: 35.7% A-: 6.3% B+: 8.5% B-: 1.5% AB+: 3.4% AB-: 0.6% Blood types by population Busy city street with crowd of people
Blood type O is the most common throughout the world. Blood type prevalence varies across populations and geographic regions. Researchers once sought to classify people into distinct races based upon blood groups, but blood types do not fit into racial categories. Across geographic regions, O blood groups are the most common. In fact, around 63% of the world's population has this blood group. In Central and South America, the rate of O blood is much higher — close to 100% in some regions. In Eastern Europe and Central Asia, the rate of O blood is lower, and B blood is more common. That being said, B blood is the least common group across the globe. Only around 16% of the world's population has it. Across the world, Rh+ blood is much more common than Rh- blood. The lowest known rate of Rh+ blood is still high, at around 65% among the Basque people of the Pyrenees mountains. Sub-Saharan African populations have the highest rate of Rh+ blood, at around 97–99%. How is blood type inherited? Blood type is a genetic trait. However, a child can have a different blood type to both of their parents, depending on which genes they inherit. Each parent passes one allele (gene) for blood type to their child. A parent who has O blood can only pass an O allele. A and B alleles are "co-dominant." This means that a child who inherits one of each will have AB blood. For example, a mother with type A blood who passes on an A allele and a father with type B blood who passes on the B allele will have a child with AB blood. Parents pass on Rh factor in the same way. Rh+ blood is dominant. This means that if a child inherits one Rh+ allele and one Rh- allele, the child will have Rh+ blood. To be Rh-, the child must inherit two Rh- alleles. This is because it is recessive. In 2015, researchers identified an enzyme that could "cut" antigens from blood cells. In theory, this would allow doctors to change a person's blood type, potentially making it easier for them to get a transfusion. However, the researchers had to use very large quantities of the enzyme, and they did not test their theory in human participants. Although it might one day be possible, doctors cannot currently change a person's blood type. Compatibility for transfusions Blood type compatibility chart
A person can only give blood to someone with compatible blood antigens. People with Rh- blood can give blood to both Rh- and Rh+ recipients. However, those with Rh+ blood cannot give to Rh- recipients. If a person receives blood from someone with an incompatible blood type, it can cause a life threatening immune system reaction. The blood transfusion will likely fail. A person with type O blood can donate to anyone, as long as the Rh factor is compatible. This means that people with O+ blood can donate to someone with A+, AB+, B+, or O+ blood, but not to people with O-, B-, AB-, or A- blood. O- is a universal donor, which means that a person with this blood type can donate to anyone. A person with type AB blood is a universal recipient, as long as the Rh factor is compatible. This means that they can receive blood from all other blood groups. People with group AB, A, or B blood can only donate to people with the same blood group type. Thank you for supporting Medical News Today Summary Having a rare blood type makes it more difficult for a person to receive a blood transfusion. It can also increase the risk of certain health complications, especially following an organ transplant and during pregnancy. People who are curious about their blood type can ask a doctor for a quick blood test. Many people learn their blood type when they donate blood for the first time. People with rare blood types should ask a doctor about access to safe blood transfusions.
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Inflammation in late teens linked to mortality risk decades later

Using data from more than 100,000 males and spanning more than 3 decades, a new study investigates the long term effect of inflammation in early adulthood.
Father and son moment
Could inflammation in early adulthood influence disease risk more than 30 years on?

Inflammation is part of the body's natural response to harmful stimuli, such as irritants, damaged cells, and pathogens.

The body uses this process to eliminate the threat, clear out damaged cells, and repair tissues.

Although inflammation is a force for good, if it continues for extended periods, which doctors refer to as chronic inflammation, it can lead to health issues.

Over recent years, it has become clear that inflammation can cause or advance several common diseases.

However, to date, little is known about how inflammation in early adulthood might influence health in later life.

A new research letter that features in JAMA Pediatrics investigates this question. The authors conclude that inflammation earlier in life increases the risk of cancer and cardiovascular disease 30 years later.

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Inflammation in youth

To investigate, researchers from the Memorial Sloan Kettering Cancer Center in New York City, NY, and other institutions in the United States, the United Kingdom, Iceland, and Sweden took data from Swedish army conscripts.

In all, they had access to data from 248,488 conscripts to the Swedish army. These individuals were 16–20 years of age between 1952 and 1956.

From this group, the researchers removed anyone who had an existing medical issue or "marked physical weakness," which left 106,120 participants.

The participants underwent a medical exam as part of their conscription, during which the army doctors took blood samples. One of the tests assessed the erythrocyte sedimentation rate (ESR).

ESR is a nonspecific marker of inflammation that measures how quickly red blood cells settle at the bottom of a test tube of blood. A high score means that the cells sink faster than average, which is a sign of inflammation.

The researchers assigned each male's ESR scores to one of three groups: low, moderate, or high.

They followed the participants for a mean duration of 35 years, up to a maximum age of 57 years. Over this time, there were 4,835 deaths.

35 years on

The scientists identified an association between high ESR scores and an increased risk of overall mortality. Similarly, there was a link between elevated ESR and an increased risk of death from cardiovascular disease or cancer.

However, there was no such relationship between ESR and death due to alcohol or drugs, suicide, traffic accidents, or falls. The authors summarize their findings:

"In this large study, we observed inflammation during late adolescence to be positively associated with premature mortality due to cancer and [cardiovascular disease]."

Scientists have already linked inflammation to cancer and to atherosclerosis, which is the clogging up of arteries — the driving force behind cardiovascular disease. However, it is surprising that there may be signs of these relationships at such a young age.

As the authors write, "these data highlight the existence of detectable markers of premature mortality at an early stage of life."

Earlier work from the same group backs up these new findings. In a study using the same dataset, the researchers described a link between ESR in late adolescence and colorectal cancer.

In the earlier study, they found that participants with elevated ESR had a 63% higher risk of developing colorectal cancer 3 decades later.

However, a study looking at ESR and prostate cancer using the same data did not find an effect.

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Although the researchers had access to a large volume of data, the study still had limitations. For instance, the army doctors only took blood tests at one point in time, so it is not possible to know how levels of inflammation fluctuated across the decades.

Also, the researchers could not account for smoking in their analysis. However, they write that "smoking is not strongly associated with ESR" and explain that even after they excluded cancers for which smoking is a known causative factor, the results remained significant.

As the dataset only includes males, there is also the possibility that the results might not be relevant for females.

The authors hope that the findings will inspire future research, explaining that the "[r]esults demonstrate the need to better understand the role of subclinical early life inflammation in relation to later life health outcomes."

The concept that a simple blood test can measure biomarkers of mortality risk more than 30 years before death is likely to be controversial. The findings unearth many more questions than they put to bed. Scientists will need to delve deeper to confirm these surprising conclusions.

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How can mouthwash interfere with the benefits of exercise?

Surprising new research shows that antibacterial mouthwash can limit the cardiovascular benefits of exercise. The effect of mouthwash on mouth bacteria interferes with a complex molecular mechanism that usually sustains the blood pressure-lowering effects of exercise.
close up of hands pouring mouthwash
Antibacterial mouthwash may help oral health, but new research shows that it interferes with the cardiovascular benefits of exercise.

The bacteria in our mouths play a key role in our health. An analysis of oral microbes from tens of thousands of people, for example, found an association between bacteria that can cause gum disease and a higher risk of esophageal cancer.

Other studies have exposed the mechanism by which a mouth bacterium can speed the growth of colorectal tumors and shown how oral bacteria can impair respiratory health. Finally, some research has also linked gum disease with higher dementia risk.

New research zooms in on another fascinating role that oral bacteria play in our health — namely, that they help us get cardiovascular benefits from exercise.

Raul Bescos, a lecturer in dietetics and physiology at the University of Plymouth, United Kingdom, is the lead author of the new study, which shows how mouth bacteria mediate the blood pressure-lowering effects of exercise and how the use of antibacterial mouthwash interferes with this process.

The new paper appears in the journal Free Radical Biology and Medicine.

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Nitric oxide, nitrate, and nitrite

The study's lead author explains the motivation for the new research, saying, "Scientists already know that blood vessels open up during exercise, as the production of nitric oxide increases the diameter of the blood vessels (known as vasodilation), increasing blood flow circulation to active muscles."

"What has remained a mystery is how blood circulation remains higher after exercise, in turn triggering a blood pressure-lowering response known as postexercise hypotension."

Nitric oxide breaks down into nitrate, explains Bescos. This process is the beginning of a circular molecular reaction, which, in the end, results in the sustained blood pressure-lowering effects of exercise.

"[R]esearch over the last decade has shown that nitrate can be absorbed in the salivary glands and excreted with saliva in the mouth," explains Bescos. "Some species of bacteria in the mouth can use nitrate and convert [it] into nitrite — a very important molecule that can enhance the production of nitric oxide in the body."

"And when nitrite in saliva is swallowed, part of this molecule is rapidly absorbed into the circulation and reduced back to nitric oxide. This helps to maintain a widening of blood vessels, which leads to a sustained lowering of blood pressure after exercise."

"We wanted to see whether blocking nitrate's ability to convert into nitrite by inhibiting oral bacteria [through the use of mouthwash] would have any effect on postexercise hypotension."

Raul Bescos

How mouthwash reduces exercise benefits

To find out, Bescos and team asked 23 healthy adults to participate in two acute bouts of exercise. For each of these, the participants ran on a treadmill for 30 minutes, and the researchers monitored the participants' blood pressure for 2 hours after the exercise.

At 1, 30, 60, and 90 minutes after the run, the participants rinsed their mouths with either antibacterial mouthwash or the control substance, which was mint flavored water. The team also collected blood and saliva samples just before exercise and 2 hours after.

The team used "a randomized, double blind and crossover [study] design," meaning that neither the testers nor the participants knew who was receiving mouthwash and who was using a placebo.

The trial revealed that the placebo intervention resulted in an average reduction of 5.2 milligrams of mercury (mm Hg) in systolic blood pressure at 1 hour postexercise. In contrast, rinsing with antibacterial mouthwash resulted in a reduction of only 2.0 mm Hg.

The results suggest that mouthwash reduced the blood pressure-lowering effects by more than 60% in the first hour of postexercise recovery and canceled them completely after 2 hours.

Also, "Previous research has suggested that nitric oxide was not involved in [the] postexercise response — and only involved during exercise — but the new study challenges these views," explains Bescos.

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Challenging preexisting notions

The prevailing notion has been that the primary source of nitrite in the blood after exercise is nitric oxide that the body creates in endothelial cells during exercise. Endothelial cells are the cells that line the inside of blood vessels.

However, the results of the new study contradict this because blood nitrite levels did not rise after exercise in the participants who had used mouthwash. Blood nitrite levels only rose after exercise when participants rinsed with the control substance.

These findings indicate that mouth bacteria are the main source of circulating nitrite, at least in the recovery period immediately after exercise.

Study co-author Craig Cutler comments on the significance of the findings, saying: "[O]ral bacteria are the 'key' to opening up the blood vessels. If they are removed, nitrite can't be produced, and the vessels remain in their current state."

"These findings show that nitrite synthesis by oral bacteria is hugely important in kick-starting how our bodies react to exercise over the first period of recovery, promoting lower blood pressure and greater muscle oxygenation."

Craig Cutler

"The next step," continues Cutler, "is to investigate in more detail the effect of exercise on the activity of oral bacteria and the composition of oral bacteria in individuals under high cardiovascular risk."

"[In the L]ong term, research in this area may improve our knowledge for treating hypertension — or high blood pressure — more efficiently."

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Just 2 glasses of soft drinks daily tied to higher death risk

A new study looking at hundreds of thousands of individuals has linked higher consumption of soft drinks with greater risk of premature death. The researchers saw that the association held for both artificially and sugar sweetened drinks.
man staring at vending machine
Most soft drinks pose a health risk, and new research finds that two glasses of soft drinks per day may raise early death risk.

Because the findings are that of an observational study, they do not prove that regular soft drink consumption drives early death. However, the research team concludes that the results endorse health initiatives to reduce public consumption of such beverages.

A recent paper in JAMA Internal Medicine describes how the international study group analyzed data on 451,743 adults from 10 European countries.

The data came from the European Prospective Investigation into Cancer and Nutrition (EPIC).

EPIC is an ongoing cohort whose participants enlisted between 1992 and 2000 and who live in Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom.

On enrolment, the participants gave information about their food and drink consumption, either by filling in questionnaires or in interviews. Their average age was 51 years old, and 71% were female. None had heart disease, cancer, diabetes, or stroke at the outset.

Of the participants taking part in the analysis, 41,693 died during a follow-up that averaged 16.4 years and ranged from 11.1 years in Greece to 19.2 years in France.

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Fruit juice not among the 'soft drinks'

The researchers compared deaths during the follow-up in those who said that they drank soft drinks every day with those who said that they consumed hardly any — that is fewer than one glass per month.

The team defined one glass as 250 milliliters (8.5 fluid ounces). Soft drink consumption included drinking of fizzy soft drinks such as cola and lemonade; isotonic or energy drinks; diet and low-calorie soft fizzy drinks; and diluted syrups, such as fruit cordial or squash. Soft drink consumption did not include fruit juice.

Their analysis revealed that consuming two or more glasses per day of total, sugar sweetened, and artificially sweetened soft drinks was linked to a higher risk of death from all causes in comparison to consuming hardly any soft drinks. The team observed the link in both males and females.

At the study outset, the participants also answered questions about their health and lifestyle.

From this information, the researchers were able to rule out any influence from factors such as physical activity, body mass index (BMI), education, smoking, and diet.

A further analysis also revealed that in comparison to consuming hardly any, drinking two or more glasses per day of artificially sweetened soft drinks was tied to a higher risk of circulatory diseases.

In the cases of sugar sweetened soft drinks, the link was to a higher risk of death from digestive diseases.

"No association," write the authors, "was observed between soft drink consumption and overall cancer death."

'Marker of overall unhealth[ful] diet'?

In a discussion of the findings, the researchers note that regardless of whether they included or removed the potential influence of BMI, the results were unchanged.

They also found positive links between total, artificially, and sugar sweetened soft drinks with deaths from all causes, as well as deaths from circulatory and digestive diseases among participants whose BMI was in the healthy range.

Such results would suggest that the links that they observed were likely not related to body fat. They support the idea that the link between soft drinks and premature death occurs through other routes.

In a comment to the Reuters news organization, study co-author Neil Murphy, Ph.D., of the Section of Nutrition and Metabolism at the International Agency for Research on Cancer, in Lyon, France, suggests that "high soft drink consumption may be a marker of overall unhealth[ful] diet."

According to the Centers for Disease Control and Prevention (CDC), there is an association between the consumption of sugar sweetened beverages and less healthful behaviors in the United States.

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Differences in gut bacteria may predispose to heart attacks

A small study has recently made two breakthrough discoveries. First, that the bacteria present in coronary (heart) plaques are pro-inflammatory, and second, that some people with heart disease harbor different sets of gut bacteria that may contribute to their risk of a heart attack.
doctor advising patient in hospital
Some researchers believe that gut bacteria may hold clues about who is more at risk of experiencing a heart attack.

According to data from the Centers for Disease Control and Prevention (CDC), approximately 735,000 individuals in the United States experience a heart attack each year.

Heart attacks can occur when a person has developed heart disease. A key feature of heart disease is the buildup of plaque in the arteries. Plaque is made up of fat, calcium, and other substances.

However, some people are more predisposed to heart attacks than others, even within a cohort whose members all have heart disease. So, researchers have been trying to understand why this happens.

Last week, Eugenia Pisano from the Catholic University of the Sacred Heart in Rome, Italy, and her colleagues presented their findings on this topic at the European Society of Cardiology Congress. This year, the congress took place in Paris, France.

In a small study, Pisano and team investigated how bacteria might influence the stability of coronary plaques. Coronary plaques form in the heart's arteries, and when they become unstable, a heart attack can follow.

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For the study, the researchers worked with 30 individuals who had acute coronary syndrome. Coronary syndrome refers to a multitude of conditions and events characterized by reduced blood flow to the heart. These conditions and health events include unstable angina and myocardial infarction (heart attack).

Additionally, the researchers also recruited 10 participants with stable angina, which is a heart condition characterized by chest pain and discomfort.

The team collected fecal samples from all the participants so that they could isolate gut bacteria. They also extracted and analyzed coronary plaque bacteria from angioplasty balloons. Doctors use angioplasty balloons to widen coronary arteries to improve blood flow.

First of all, the researchers found that the bacteria present in coronary plaques were pro-inflammatory, primarily belonging to species, such as Proteobacteria and Actinobacteria.

"This suggests a selective retention of pro-inflammatory bacteria in atherosclerotic plaques, which could provoke an inflammatory response and plaque rupture," says Pisano.

In comparison, fecal samples had a heterogeneous bacterial composition, featuring mainly bacterial strains, such as Bacteroidetes and Firmicutes.

The researchers also discovered that the gut bacteria populations differed between the two groups of participants. Individuals with acute coronary syndrome had a higher proportion of Firmicutes, Fusobacteria, and Actinobacteria in their guts, whereas people with stable angina had a stronger Bacteroidetes and Proteobacteria presence.

"We found a different make-up of the gut microbiome in acute and stable patients," notes Pisano. This suggests that "[t]he varying chemicals emitted by these bacteria might affect plaque destabilisation and consequent heart attack."

"Studies are needed to examine whether these metabolites do influence plaque instability," the researcher advises, since, so far, it remains unclear to what extent bacteria present in the gut or on coronary plaques influence the development of a heart attack.

However, Pisano, adds: "While this [current] study is a small study, the results are important because they regenerate the notion that at least in a subset of patients, infectious triggers might play a direct role in plaque destabilization."

"Further research will tell us if antibiotics can prevent cardiovascular events in certain patients. Microbiota in the gut and coronary plaque could have a pathogenetic function in the process of plaque destabilization and might become a potential therapeutic target."

Eugenia Pisano

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Heart attack risk higher in those who sleep too little or too much

The right amount of sleep is protective of heart health. This was the conclusion of new research that found sleep duration can influence a person's risk of heart attack, regardless of other heart risk factors, including genetic ones.
man sleeping
New research tracks sleep duration and a person's risk of a heart attack.

In a recent Journal of the American College of Cardiology paper, scientists from the United States and the United Kingdom describe how they analyzed sleep habits and medical records of 461,347 people aged 40–69 years living in the U.K.

The data, which came from the UK Biobank, included self-reports of how many hours participants habitually slept per night and health records covering 7 years. It also included results of tests for risk genes.

The analysis revealed that those who slept less than 6 hours per night had a 20% higher risk of a first heart attack in comparison to those who slept 6–9 hours. Those who slept more than 9 hours had a 34% higher risk.

The researchers also found that keeping sleep duration to 6–9 hours per night can reduce the risk of a first heart attack by 18% in those people with a "high genetic liability" for developing heart disease.

"This [study]," says senior study author Celine Vetter, Ph.D., an assistant professor of integrative physiology at the University of Colorado at Boulder, "provides some of the strongest proof yet that sleep duration is a key factor when it comes to heart health — and this holds true for everyone."

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Sleep duration is an independent risk factor

Studies have been finding links between sleep habits and heart health for some time now. However, most of those findings have come from observational studies: these studies that can only confirm links but cannot establish the direction of cause and effect.

Because many factors affect both sleep and heart health, it is not easy to determine whether poor sleep makes for poor heart health or poor heart health leads to poor sleep.

Vetter and her colleagues sought to meet this challenge by using data from a vast number of individuals, combining it with genetic research, and ruling out dozens of potential influencing factors.

Altogether, they adjusted the results to remove the potential effect of 30 factors that can influence both heart health and sleep. These factors include physical activity, mental health, income, education, smoking, and body composition.

The researchers' results showed that sleep duration was an independent risk factor for heart attack.

The researchers found that the risk of heart attack increased the further that people's habitual night sleep diverged from 6–9 hours.

Individuals who slept 5 hours each night, for example, had a 52% higher risk of a first heart attack than those who slept 7–8 hours. Individuals who slept 10 hours per night had double the risk.

Analysis using gene variants for short sleep

The team then used a method called Mendelian randomization (MR) to confirm that short sleep duration was an independent risk factor for heart attack.

The MR analysis showed that individuals with gene variants that predisposed them to short sleep had a higher risk of heart attack.

Previous studies have uncovered more than 2 dozen variants associated with short sleep duration.

By using genetic variants, MR can determine whether an observational link between a risk factor and a disease is consistent with a causal effect.

"This gives us even more confidence that there is a causal relationship here – that it is sleep duration, not something else, influencing heart health," Vetter argues.

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Sleep is key to heart health

According to the Centers for Disease Control and Prevention (CDC), more than one-third of adults in the U.S. sleep less than the recommended 7 hours per night.

The CDC recommend the following tips for good sleep:

Go to bed and rise at the same time every day, even at the weekend. Get enough natural light — especially earlier in the day. Avoid exposure to artificial light, particularly in the hours up to bedtime. Get enough daily exercise and avoid exercising near bedtime. Avoid eating and drinking in the hours before bedtime — especially alcohol and high fat and sugar-rich foods. If difficulties persist, seek medical advice to help identify obstacles to sleep, including other health conditions.

The latest research team hopes that its findings will raise awareness among doctors, the public, and policymakers about the impact of sleep on heart health.

"It's kind of a hopeful message," says first study author Iyas Daghlas, who is studying medicine at Harvard Medical School in Boston, MA, "that regardless of what your inherited risk for heart attack is, sleeping a healthy amount may cut that risk just like eating a health[ful] diet, not smoking, and other lifestyle approaches can."

"Just as working out and eating health[fully] can reduce your risk of heart disease, sleep can too."

Celine Vetter, Ph.D.

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Type 2 diabetes, obesity: Weight loss surgery may lower death risk

New research finds significant health benefits associated with weight loss surgery in people with obesity.
closeup of surgeons
Weight loss surgery may have a host of beneficial effects in people with obesity.

More than 1 in 3 adults in the United States are overweight or have obesity, according to data from 2013–2014.

Type 2 diabetes, high blood pressure, heart disease, and stroke are only some of the complications associated with obesity.

New research presented at the European Society of Cardiology Congress, which takes place, this year, in Paris, France, suggests that bariatric, or weight loss, surgery can reduce the risk of premature mortality and cardiovascular problems more than standard medical care.

Dr. Steven Nissen, Chief Academic Officer of the Heart & Vascular Institute at the Cleveland Clinic, in Ohio, is the senior author of the study, which also appears in the Journal of the American Medical Association.

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Dr. Nissen and the team looked at data from 13,722 participants, 2,287 of whom had obesity and type 2 diabetes and had undergone weight loss surgery. The researchers compared data from this group with information from 11,435 matched controls who had only received standard medical care.

Of the 2,287 participants who underwent weight loss surgery, 75% had a body mass index (BMI) of 40 or above, which constitutes "extreme obesity." The minimum BMI in the group was 30, which is the lower threshold for obesity.

The participants in the surgery group had each undergone one of four types of weight loss, or metabolic, procedure: gastric bypass, sleeve gastrectomy, adjustable gastric banding, or duodenal switch.

The main outcomes that the researchers looked for were death, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and kidney disease. These are the main complications of obesity and type 2 diabetes.

The research revealed that the people who had undergone weight loss surgery had a 40% lower risk of any of these events over an 8-year follow-up period. The risk of death, specifically, was 41% lower.

Furthermore, people who had undergone metabolic surgery lost 15% more weight, on average, and had 15% lower blood sugar levels.

Dr. Ali Aminian, a bariatric surgeon at the Cleveland Clinic and the first author of the paper, comments on the findings. He says, "The striking results that we saw after metabolic surgery may be related to the patients' substantial and sustained weight loss."

"However, there is a growing body of evidence to suggest that there are beneficial metabolic and hormonal changes after these surgical procedures that are independent of weight loss."

"Cardiovascular complications from obesity and diabetes can be devastating," adds Dr. Nissen.

"Now that we've seen these remarkable results, a well-designed randomized controlled trial is needed to definitively determine whether metabolic surgery can reduce the incidence of major heart problems in patients with type 2 diabetes and obesity."

Dr. Steven Nissen

The authors acknowledge that there were some limitations to their study. First, its observational nature cannot prove causality.

Secondly, misdiagnoses in the Cleveland Clinic's electronic health records — the database from which the researchers took their information — may have biased the results.

Thirdly, "To assess status of diabetes and cardiovascular medications in follow-up, the study assessed prescription orders for medications, which does not necessarily equate to actual medication use," write the researchers.

Furthermore, the authors did not compare the results of the different types of weight loss surgery, and fewer than 10% of the participants in the control group had taken drugs that have significant cardiovascular benefits.

However, the sensitivity of the analyses that the researchers carried out guarantee the robustness of the findings, reassure the authors.

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What are the side effects of Lipitor? An overview

Lipitor is the brand name of the medication atorvastatin, which is a statin that reduces blood cholesterol. The risk of experiencing side effects when taking this drug is low.

According to the American College of Cardiology, about 85–90% of people report no side effects from taking statins. When side effects do occur, the most common are muscle pain and joint pain.

In this article, we discuss the side effects and other possible risks of taking Lipitor.

What are statins used for? a man about to take lipitor who may experience side effects
A doctor may prescribe Lipitor to help reduce a person's cholesterol.

Lipitor is a statin, which is a class of drug that helps lower cholesterol levels by reducing the amount of this substance that the liver produces.

Lipitor lowers the levels of cholesterol and lipoprotein in the blood and reduces how much low density lipoprotein (LDL), or "bad" cholesterol, the body produces.

As a result, this medication helps lower the risk of heart related health events in people with risk factors for these issues. Lipitor can help reduce a person's risk of heart attack, stroke, congestive heart failure, and angina. A person at high risk is also less likely to need stents or bypass surgery when they take this drug.

People who are at risk for coronary heart disease may benefit from taking Lipitor. Lipitor can also help people with an abnormal lipid profile and those with type 2 diabetes who have cardiac risk factors.

Thank you for supporting Medical News Today Common side effects People taking Lipitor may experience side effects, the most common of which include: Muscle pains and cramps are more likely when a person first starts taking Lipitor or when they increase their dosage. People who are 65 years of age or older may be more at risk of this side effect than younger adults. Sometimes, doctors will notice that people experiencing muscle pains with Lipitor also have high levels of a liver protein called creatine phosphokinase. If this is the case, they will monitor the levels of this protein while decreasing the dosage of Lipitor. They may choose to replace Lipitor with another cholesterol lowering drug. Doctors will perform liver function tests before prescribing Lipitor, as it can affect the results of these tests. After taking the drug for at least 6 weeks, doctors will recheck the liver to make sure that the drug has not caused any significant changes to the liver function. If the person has elevated test results, the doctor will check their blood at more frequent intervals until the measures normalize. Sometimes, the doctor may need to lower the dosage of Lipitor or stop this treatment altogether. Severe side effects woman sitting on the floor with washing holding side in pain
Possible side effects of Lipitor include muscle pain, nausea, and indigestion. Severe side effects are rare, but they can occur. Lipitor may affect kidney or liver function. Research has linked Lipitor to a serious muscle condition called rhabdomyolysis, which can cause kidney failure. If this occurs, doctors will stop the drug and provide the individual with plenty of fluids to prevent kidney failure. People who have kidney disease or take certain other medications alongside Lipitor may be more at risk of developing rhabdomyolysis. The three symptoms of this condition are: muscle weakness muscle pain tea colored urine However, doctors report that fewer than 10% of people will have all three symptoms. Doctors diagnose rhabdomyolysis by checking the blood levels of creatine phosphokinase. Most experts agree that a number five times the normal limit can confirm a diagnosis of rhabdomyolysis. Statins and other cholesterol lowering medications can affect the function of the liver. At higher dosages, the risk of liver function test abnormalities increases. In rare cases, people have experienced fatal and nonfatal liver failure as a result of taking statins. Warnings Anyone with an allergy to atorvastatin or any other statin should avoid taking Lipitor. Women who are pregnant, wish to become pregnant, or are breastfeeding should not take Lipitor. There is not enough evidence to confirm that Lipitor is safe or effective during pregnancy or breastfeeding. If a woman becomes pregnant while taking Lipitor, the doctor will stop the medication and replace it with another cholesterol lowering medication. Doctors will not usually prescribe Lipitor to anyone with active liver disease, but in some situations, the benefits of taking Lipitor may outweigh the risks. People with chronic liver disease, such as hepatitis or nonalcoholic liver disease, may still take Lipitor. People should also avoid drinking excessive amounts of alcohol while taking Lipitor. Drug interactions Lipitor can interact with some other drugs to increase the risk of rhabdomyolysis. Birth control pills and grapefruit juice can also affect how Lipitor works. The following table lists Lipitor's potential drug interactions, which can cause rhabdomyolysis and other skeletal muscle effects. Drugs What to do CyclosporineTipranavir + ritonavirGlecaprevir + pibrentasvir Do not take with Lipitor. ClarithromycinItraconazoleSaquinavir + ritonavirDarunavir + ritonavirFosamprenavirFosamprenavir + ritonavirElbasvir plus grazoprevir Do not take with more than 20 mg of Lipitor daily. Nelfinavir Do not take with more than 40 mg of Lipitor daily. Lopinavir + ritonavirSimeprevirFibric acid derivativesErythromycinAzole antifungalsLipid-modifying doses of niacinColchicine Use with caution and at the lowest possible dosage. People taking birth control pills with Lipitor may have higher levels of progesterone and estrogen in the bloodstream. Doctors need to choose an appropriate birth control pill that will not interact with Lipitor. People who take Lipitor must avoid drinking grapefruit juice. The body uses an enzyme called CYP3A4 to digest Lipitor. Drinking more than 1.2 liters of grapefruit juice per day can block the action of this enzyme and raise the levels of Lipitor in the blood. Thank you for supporting Medical News Today What to do if you have side effects doctor in consultation with patient
A person should report any side effects that they are experiencing to their doctor. Muscle pains and cramps are a common side effect of taking Lipitor, but a person should notify a doctor if they experience them. The doctor can then test the person's liver function. People should also report any side effects that affect their quality of life. Lipitor is an effective medication to prevent heart related events, but it only works if a person takes it daily according to the prescription. People who have tea colored urine or notice that their skin or the whites of their eyes are turning yellow should seek emergency medical attention. These symptoms can indicate liver failure. If a doctor is aware of the side effects that a person is experiencing, they can help them find an alternative cholesterol lowering medication that will be effective and safe. Summary Lipitor is an effective medication that doctors prescribe to prevent cardiovascular disease in people with cardiac risk. Some people may experience side effects, such as diarrhea, nausea, and indigestion, when taking Lipitor. Other side effects, such as rhabdomyolysis and liver function abnormalities, can be more severe and may require immediate medical attention. Doctors will monitor a person's liver function regularly to detect any signs of liver function abnormalities before symptoms arise. Some other drugs can interact with Lipitor, so doctors will need to take a full medical history before prescribing Lipitor.
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Exercise may help people with cardiovascular disease the most

New research comparing the benefits of exercise for healthy people versus people with cardiovascular disease found that the latter may benefit the most from being physically active.
person running on country road
A study shows, for the first time, that people with cardiovascular disease benefit more from exercise than healthy people.

Existing evidence shows that staying physically active can help a person live longer and that regular exercise can help prevent many chronic conditions, including cardiovascular disease.

However, no studies had looked at how exercise really benefits individuals who already have cardiovascular disease.

Now, for the first time, researchers — many from Seoul National University, in South Korea — have compared the effects of exercise on the risk of death in a cohort of healthy participants and a cohort of participants with preexisting cardiovascular disease.

The study revealed that individuals with cardiovascular disease seemed to benefit more from exercise than healthy individuals — and the more they exercised, the better.

The team, led by Dr. Sang-Woo Jeong, published the findings in the European Heart Journal last week and also presented them at the European Society of Cardiology (ESC) Congress 2019, held in Paris, France.

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14% death risk reduction over 6 years

Dr. Jeong and colleagues analyzed the data of 441,798 participants, who were part of the Korean National Health Insurance Services Health Screening Cohort.

Of these, 131,558 participants had preexisting cardiovascular disease, while 310,240 were healthy. All of the participants were aged 40 or over, with an average age of 60. All had taken part in a health screening program between 2009 and 2015 and had provided information about their levels of physical activity.

In their analysis, the researchers also had access to follow-up data for nearly 6 years, as well as information regarding death and its cause, accessed through the Korean National Death Index.

The participants provided information on their levels of physical activity via surveys that asked them to report how often they had been physically active in the past week. In this case, physical activity referred mainly to instances of aerobic exercise and did not include daily activities, such as housework.

The researchers converted these data into units of metabolic equivalent task minutes per week (MET-mins/week), which allowed them to quantify levels of activity.

Dr. Jeong and the team found that, after the 6-year follow-up period, the participants with cardiovascular disease had benefitted more from physical activity than the healthy participants.

More specifically, for every 500 MET-mins/week, healthy individuals saw a 7% reduction in premature death risk, while those with cardiovascular disease saw a 14% death risk reduction.

Among healthy individuals, those who saw the most benefits were those who undertook 0–499 MET-mins/week of exercise. The benefits were less significant for healthy people who undertook 500–1,000 MET-mins/week, only increasing again after the 1,000 MET-mins/week landmark.

As for participants with cardiovascular disease, once more, individuals who undertook 0–499 MET-mins/week of exercise saw the most significant benefits. However, in this cohort's case, risk reduction continued to rise beyond the 500 MET-mins/week point.

Yet, at the same time, the researchers noted that almost 50% of all participants exercised very little, and about 25% of participants reported no physical activity.

"We found that approximately half of the people in the study did not reach the recommended level of leisure-time physical activity, and a quarter had a totally sedentary lifestyle," says Dr. Jeong.

"People with cardiovascular disease had lower levels of physical activity than those without, but the more exercise people did, the lower their risk of death during the 6 years of follow-up. The main new finding of this study is that people with cardiovascular disease benefit from a physically active lifestyle to a greater extent than healthy people without cardiovascular disease," Dr. Jeong explains.

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How to reach desired activity levels

As to why individuals with cardiovascular disease derive greater benefits from exercise than healthy individuals, the researchers can only make conjectures.

"There may be several plausible explanations for why people with [cardiovascular disease] benefited the most from exercise. First, sedentary lifestyle is a well-known risk factor for [cardiovascular disease]. Patients with [cardiovascular disease] may have had sedentary lifestyles, and thus, changing their lifestyle to become more physically active may be more beneficial," notes study co-author Dr. Si-Hyuck Kang.

"Secondly," he adds, "a number of previous studies have shown that physical activity helps control cardiovascular risk factors such as blood pressure, cholesterol, and blood glucose. The benefit of physical activity in secondary prevention may come by better controlling such risk factors."

"Lastly, patients with [cardiovascular disease] usually have higher levels of systemic inflammation than those without [this condition], and there is evidence that physical activity lowers systemic inflammatory levels," Dr. Kang explains.

The researcher also goes on to advise that doctors encourage individuals with cardiovascular problems not to give up on exercise and explain just how physical activity can benefit health.

"The 2016 ESC guideline for primary prevention recommends healthy adults of all ages should perform at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity aerobic physical activity, or an equivalent combination," Dr. Kang notes.

"One way you can achieve 500 MET-minutes a week is to do brisk walking for 30 minutes, five times a week. If you are very busy [...], the other way to achieve approximately 500 MET-minutes a week is to do vigorous physical activity, such as climbing hills with no loads, for 75 minutes, once a week."

Dr. Si-Hyuck Kang

"You can achieve 1,500 MET-minutes a week by doing brisk walking for 30 minutes, five times a week, plus climbing hills for 2.5 hours, once a week," Dr. Kang also suggests.

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Is allulose a healthful alternative to sugar?

People use allulose as a sugar substitute. People with diabetes and obesity can benefit from this sugar substitute because it is low in calories and has little effect on blood sugar.

According to a 2019 study, allulose has "the bulk and the mouth fill of table sugar with reduced caloric content," making it an attractive sweetener. This study also suggests that scientists need to carry out more high quality research to confirm the long term safety and effectiveness of sweeteners, such as allulose.

Continue reading to explore the benefits and risks of adding allulose to your diet.

What is allulose? a spoonful of allulose
Allulose is a lower calorie alternative to everyday sugar.

Allulose is a type of sugar that resembles fructose, which is the sugar that occurs naturally in fruit.

It is available in a granulated form and looks like everyday sugar. The scientific name for sugar is sucrose. Allulose is a low calorie sweetener that has 70% of the sweetness of sucrose.

According to the Food and Drug Administration (FDA), allulose provides about 0.4 calories per gram (g), which is significantly lower than the 4 calories per g in sugar. In addition, the body absorbs allulose but does not metabolize it into glucose, so it is virtually calorie free. According to the FDA, allulose has little to no effect on blood glucose or insulin levels.

Scientists can produce allulose in the laboratory, but it is also found naturally in some foods, such as dried fruits, brown sugar, and maple syrup.

Other names for allulose include psicose, d-psicose, d-allulose, or pseudo-fructose.

Thank you for supporting Medical News Today Is allulose good for you? Allulose contains fewer calories than sugar and appears to have no effect on blood glucose levels. This means it could be a healthful alternative to sugar. Doctors agree that sugar is a significant contributory factor to obesity. Obesity has associations with metabolic disorders, such as diabetes, high cholesterol, and cardiovascular diseases. Substituting high caloric sugars with a low calorie alternative, such as allulose, may help control obesity rates. A small-scale study from 2015 suggests that allulose may have benefits for type 2 diabetes and obesity. The researchers report that allulose may help to control glucose levels and improve insulin resistance. Much of the research into the effects of allulose have used animal models. In one human study, researchers looked at whether allulose could help reduce body fat, affect blood cholesterol, and affect markers of diabetes. The results showed that those who consumed a high dose allulose beverage had significant decreases in body fat percentage, body fat mass, and body mass index (BMI) compared with those taking a placebo. Researchers used CT scans to examine changes in the participants' abdominal fat area. At the end of the study, the people who consumed the high dose allulose drink had a significant decrease in total fat areas compared with those taking a placebo. The study also reported that allulose had little effect on the levels of fat in people's blood. Levels of triglycerides, total cholesterol, and low density lipoprotein (LDL) cholesterol were unchanged in all groups. The study also found no differences in the markers linked with diabetes, including fasting blood glucose, glycated hemoglobin, blood glucose, and insulin levels between the allulose and placebo groups. The results of this study show that replacing sugar with allulose may offer potential benefits for those who are overweight or obese. Only a small number of volunteers participated in this study, so researchers need to carry out further studies in a more diverse study population to confirm these results. How to use allulose a bowel of sorbet
The FDA have approved of the use of allulose in many frozen desserts. Allulose is not as sweet as sugar. People replacing sugar with allulose may find they need to use more allulose to achieve the same amount of sweetness they would get from sugar and other sugar substitutes. The FDA have approved the use of allulose in: selected bakery products, such as sweet rolls, cakes, and pastries nonalcoholic beverages cereals chewing gum confections and frostings frozen dairy desserts, such as ice cream, soft serve, and sorbet yogurt and frozen yogurt salad dressings gelatins pudding and fillings hard and soft candies jams and jellies sweet sauces and syrups fat based cream medical foods Possible side effects According to the FDA, people may experience some abdominal discomfort from consuming large quantities of allulose, but this side effect is not toxic and usually temporary. In one study, researchers investigated the possible side effects of consuming allulose occasionally or regularly. People reported abdominal side effects when consuming increasing doses of allulose, including: bloating abdominal pain diarrhea decreased appetite passing gas abdominal sounds Allulose vs. alternatives Allulose is a type of sugar that is found naturally in certain foods. Other sugar substitutes that people use include: stevia aspartame saccharine sucralose neotame Except for stevia, these sugar substitutes are not natural. Manufacturers make aspartame and neotame by combining two amino acids (protein building blocks found naturally in the body) and make sucralose from sucrose or table sugar. The FDA has approved these sweeteners for use in humans and classified them as generally recognized as safe. Many manufacturers of beverages, dietary products, drugs, mouthwashes, and cosmetics use these low and no calorie sweeteners instead of sugar. Manufacturers claim that artificial sweeteners can help people control hunger and appetite, lose weight, and manage diabetes. Not all scientists agree, but sweeteners are among the most researched ingredients in the food supply. Numerous medical associations and international regulatory bodies have deemed them safe when consumed in usual amounts. Thank you for supporting Medical News Today Can you use allulose in a keto or paleo diet? a woman looking out of a window and eating dried fruit.
A person following a paleo diet can eat allulose that occurs in unprocessed foods. The paleo diet consists of eating vegetables, fruits, nuts, roots, meat, and organ meats and excludes any highly processed foods. People following a paleo diet can eat allulose, but only if they consume it from natural, unprocessed food. Dried fruits, brown sugar, and maple syrup contain allulose. The keto diet is very low in carbohydrate, moderate in protein, and very high in fat. Allulose is a carbohydrate, but it does not provide calories or raise blood glucose compared with sucrose and is keto compatible. Summary Doctors suggest that sugar is one factor that contributes to obesity. Lowering the amount of sugar a person eats and substituting sugar with low or no calorie sweeteners are two ways to help prevent obesity. Compared with sugar, allulose is a low calorie carbohydrate. Some researchers suggest that allulose can help control weight and diabetes. People following the keto diet can use allulose to replace sugar. People are searching for affordable and safe sweeteners to replace sugar. Eating a large amount of allulose may cause digestive discomfort, but there are few other known side effects. The FDA has approved other sugar substitutes, such as stevia, aspartame, and sucralose, as safe when used in moderation. If a person wishes to try allulose or other sweeteners, they are available to purchase from drug stores, some supermarkets, and online stores. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above.
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AI-enhanced ECGs may soon assess overall health

Scientists have trained an artificial intelligence tool to predict sex and estimate age from electrocardiogram readouts. They suggest that, with further development, the tool could soon be helping doctors to assess the overall health of their patients.
ECG on a screen
One day, an AI-enhanced ECG could estimate a person's overall health.

An electrocardiogram, also known as an ECG or EKG, is a painless, simple test that records the electrical activity of a person's heart.

A recent paper in the journal Circulation: Arrhythmia and Electrophysiology, describes how the team developed an artificial intelligence (AI) tool to predict sex and estimate age from ECG data.

The researchers, from the Mayo Clinic College of Medicine and Science, in Rochester, MN, trained the AI tool, which is of a type known as a convolutional neural network (CNN), using ECG readouts from nearly 500,000 individuals.

When they tested the CNN's accuracy on a further 275,000 people, they found that it was very good at predicting sex but less good at predicting age. The AI tool got the sex right 90% of the time but only got the age right 72% of the time.

The team then focused on 100 people in the test batch for whom they had at least 20 years of ECG readouts.

This closer investigation revealed that the accuracy of the AI tool's age estimates depended on whether the individuals had experienced heart conditions.

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AI has potential to glean 'physiologic age'

For individuals who had experienced heart conditions, the AI tool's age estimates tended to be greater than their chronological ages.

For those who had experienced few or no heart conditions, the AI tool's age estimates were much closer to the participants' chronological ages.

The results showed that for people who had experienced low ejection fraction, high blood pressure, and heart disease, the AI tool estimated their ages to be at least 7 years greater than their chronological ages.

Ejection fraction is a measure of how well the heart is pumping.

The researchers say that these results suggest that the tool appears to be estimating biological, or physiologic, age, which, in contrast to chronological age, reflects a person's overall health status and body function.

"This evidence," says senior study author Dr. Suraj Kapa, assistant professor of medicine at the Mayo Clinic, "that we might be gleaning some sort of 'physiologic age' was certainly both surprising and exciting for [AI's] potential role in future outcomes research and may foster a new area of science where we seek to better understand the biologic underpinnings of such a finding."

Physiologic age marker to aid overall health assessment

Even people with no medical training can see that different people appear to age differently.

Scientists investigating aging research are increasingly turning to physiologic age as a way to measure progress of biological aging processes, as opposed to the simple passage of time.

To this end, they have proposed a number of biomarkers, including those that measure substances in the blood, epigenetic alterations to DNA, and the level of frailty.

Dr. Kapa and colleagues suggest that the ability to detect discrepancies between chronological age and the age suggested by the heart's electrical signals could serve as a useful biomarker for hidden heart disease and other conditions.

"Being able to more accurately assess overall health status may help doctors determine which patients they should examine further to determine if there are asymptomatic or currently silent diseases that could benefit from early diagnosis and intervention," Dr. Kapa explains.

The researchers call for more research to validate the use of the AI-enhanced ECG as a way to estimate physiologic age in healthy people.

The data that they used came from people who had undergone ECGs for clinical reasons.

"While physicians already consider whether a patient 'appears [their] stated age' as part of their baseline physical examination, the ability to more objectively and consistently assess this may impact healthcare on multiple levels."

Dr. Suraj Kapa

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Heart health: Focus on healthful foods rather than diet type

New research finds that the type of diet a person follows is not as important as simply making sure it includes healthful foods.
close up of man chopping vegetables
When it comes to cardiovascular health, the type of diet is less important than 'simply eating healthful foods,' researchers say.

Most people know that eating a healthful diet is crucial for keeping our heart and our cardiovascular system healthy. But which diet is best?

Researchers at Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA, set out to compare the effects of three diets on heart disease risks.

Each of the three diets followed the DASH pattern while focusing on one main macronutrient: carbohydrates, proteins, or unsaturated fats.

In the carbohydrates-rich diet, around 58% of kilocalories came from carbs; the protein-rich diet replaced 10% of kilocalories from carbs with protein; and the unsaturated fat diet replaced 10% of kilocalories from carbs with unsaturated fats, for example, from avocados, nuts, and fish.

Dr. Stephen Juraschek, Ph.D., an assistant professor of medicine at BIDMC and Harvard Medical School, is the corresponding author of the study.

Dr. Juraschek and team examined the effect of the three diets on cardiovascular risk factors, such as systolic blood pressure, low density lipoprotein (LDL) cholesterol, C-reactive protein levels — a marker of inflammation — and high-sensitivity troponin, which is "a marker of subclinical cardiac injury."

The researchers published their findings in the International Journal of Cardiology.

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Juraschek and team obtained their data from the so-called OmniHeart trial, a randomized intervention that followed 150 participants over 6 weeks. The average age of the participants was 54 years, 45% were women, and 55% were African American.

The researchers measured the cardiovascular risk factors at the beginning and end of each diet and compared the effects between the diets.

All three diets used the DASH dietary model, which emphasizes the consumption of vegetables, fruits, whole grains, fish, poultry, and beans.

In comparison with the baseline, the analysis revealed that all three diets had positive and prompt effects on heart health, as they all lowered the markers of inflammation and cardiac injury.

However, changing the composition of the macronutrients did not make a difference, suggesting that it does not matter whether the diet is high or low in healthful fats or carbs, but that the most important factor for improving heart injury is the general healthfulness of the diet.

"[T]hese findings suggest that a health[ful] diet, regardless of macronutrient profile, can directly mitigate subclinical cardiac damage and inflammation beyond traditional risk factors," write the researchers.

Juraschek sums up the significance of the findings, saying, "It's possible that macronutrients matter less than simply eating health[ful] foods."

"Our findings support flexibility in food selection for people attempting to eat a healthier diet and should make it easier," he continues.

"With the average American eating fewer than 2 servings of fruit and vegetables a day, the typical American diet is quite different from any of these diets, which all included at least 4 to 6 servings of fruits and vegetables a day."

"There are multiple debates about dietary carbs and fat, but the message from our data is clear: Eating a balanced diet rich in fruits and vegetables, lean meats, and high in fiber that is restricted in red meats, sugary beverages, and sweets, will not only improve cardiovascular risk factors but also reduce direct injury to the heart."

Dr. Stephen Juraschek

"Hopefully, these findings will resonate with adults as they shop in grocery stores and with health practitioners providing counsel in clinics throughout the country."

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Could bone-like particles in blood contribute to artery clogging?

Scientists have discovered that blood circulating around the body contains bone-like particles. They found the particles in blood samples from healthy humans and rats.
illustration of blood vessels
New research finds bone-like particles in the blood vessels.

They suggest that the bone-like particles could be evidence of ossification in bone marrow vessels.

The team also proposes that the particles may contribute to conditions such as atherosclerosis, a process that causes plaques, or deposits of fats and other substances, to build up inside arteries.

A recent paper in the journal Microcirculation gives a detailed account of the study.

Although most of the bone-like particles were very small, a significant proportion were large enough "to block small blood vessels throughout the vascular tree," write the authors.

The study follows previous research that uncovered a process in bone marrow whereby blood vessels "progressively and theoretically convert into bone tissue with advancing age."

That finding was the work of Rhonda D. Prisby, Ph.D., an associate professor of kinesiology at the University of Texas at Arlington, who is also the lead and corresponding author of the new study.

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Bone-like particles and vascular calcification

Prisby wondered if the processes of ossification in bone marrow blood vessels could give rise to bone-like particles that are capable of entering the bloodstream.

"By examining seemingly unrelated images and linking the details of them together," says Prisby, "I was able to posit the presence of bone-like particles in the blood."

Therefore, for the new investigation, she and colleagues used ultra-high microscopy to examine ossified bone marrow blood vessels in more detail.

They also "sought to confirm, characterize, and quantify the presence of [bone-like particles] in peripheral whole blood samples from humans and rats."

Cardiovascular diseases are the leading cause of death worldwide and were responsible for around 31% of all global deaths in 2016, according to the World Health Organization (WHO).

The WHO also estimate that, in 2016, 17.9 million people died of cardiovascular diseases, the majority of them from heart attack and stroke.

Vascular calcification is a complex and dynamic process — involving several mechanisms — that deposits calcium in the walls of blood vessels.

The process hardens the vessels, reduces their elasticity, and raises the risk of cardiovascular diseases and deaths from such diseases.

Probing the process of vascular calcification

In their study paper, Prisby and colleagues explain that the processes of vascular calcification are unclear. However, scientists suspect that the processes involve several types of cell in the vessel wall and the tissue that surrounds it.

The authors give an example involving smooth muscle cells. These cells in the vessel wall can transition from a contractile type to a bone-generating type and thence to a form that is "noncontractile, migratory, and proliferative."

This and other examples suggest that vascular calcification can start inside blood vessels.

Given that bone marrow vessels also undergo calcification, but most of the research literature on vascular calcification describes that which occurs outside the skeleton, the team decided to investigate further.

The purpose of the new study was to describe the features of bone marrow blood vessels that had become bone-like and to confirm what the team suspected — that the bloodstream contains bone-like particles, likely as a result.

The researchers used advanced microscopy techniques to examine human bone marrow blood vessels. These methods revealed two types of bone-like vessels: "transitioning" and "ossified."

They observed how transitioning vessels had bone-like particles stuck to their surfaces, meaning that, in theory, the particles could "gain access to and circulate within the blood."

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'Sharp tips and edges'

As well as examining human bone marrow vessels, the researchers examined blood samples from younger and older healthy human volunteers and rats.

They found bone-like particles in samples from both species. In neither species did age appear to make a difference to the percentage of bone-like particles.

Although most of the bone-like particles had a diameter no bigger than 15 micrometers, some were bigger and "of sufficient size to serve as emboli."

Prisby suggests that scientists should consider the potential role of bone-like particles when studying the processes of vascular calcification, heart attack, and stroke.

"Some of the ossified particles have sharp tips and edges that could damage the lining of blood vessels. This damage could initiate events leading to atherosclerosis [...] which can restrict blood flow over time."

Rhonda D. Prisby, Ph.D.

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Deaths to heart related conditions rising in the US

In the United States, total deaths to cardiometabolic disease — which includes heart disease, stroke, diabetes, and high blood pressure — have been rising since 2011, according to new research.
hands holding a white heart
New research examines the rate of cardiovascular deaths in the United States, and the racial disparities in these trends.

The recent JAMA study investigated national trends in cardiometabolic disease deaths in the U.S. during 1999–2017.

The results reveal that while the overall rate of cardiometabolic disease deaths has been falling since 1999, the decline was slower after 2010.

"Racial disparities in cardiometabolic causes of death persisted," note the authors, who found that black people are still more likely to die of these diseases than white people.

Within the overall trend, the team uncovered differences among the conditions as follows:

Rates of death due to heart disease fell during 1999–2017 but the decline was slower after 2010. Rates of death from stroke and diabetes declined up to 2010 but then leveled out.

"Our findings make it clear that we are losing ground in the battle against cardiovascular disease," says senior study author Dr. Sadiya S. Khan, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine in Chicago, IL.

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Need for a shift in health strategy

Heart disease is the leading cause of death in the U.S., where it kills around 610,000 people per year, according to the Centers for Disease Control and Prevention (CDC).

Dr. Khan states that the significant decline in deaths to cardiometabolic diseases up to 2011 has been largely due to improvements in their diagnosis and treatment.

What these recent findings suggest, however, is that there is now a need for the U.S. to shift to a new strategy.

The focus of the new strategy should be prevention if the nation is to achieve its goal of "living longer, healthier, and free of cardiovascular disease," Dr. Khan adds.

The new study draws on data from the CDC's Wide-ranging ONline Data for Epidemiologic Research (WONDER).

The researchers used data on deaths during 1999–2017, where certificates listed the underlying causes as heart disease, stroke, diabetes, or hypertension (high blood pressure).

To allow meaningful comparisons of populations whose age profiles vary over the study period, the team age adjusted the data "using the 2000 U.S. standard population."

'Inflection point' in trends was 2010

The results showed that deaths due to heart disease totaled 725,192 in 1999 and 647,457 in 2017. For stroke, these figures were 167,366 and 146,383, and for diabetes, they were 68,399 and 83,564, respectively. In the case of high blood pressure, they were 16,968 and 35,316, respectively.

In terms of age adjusted deaths per 100,000 population, heart disease deaths fell from 266.5 in 1999 to 165.0 in 2017; stroke deaths fell from 61.6 to 37.6; and diabetes ones fell from 25.0 in 1999 to 21.5 in 2017.

However, age adjusted deaths per 100,000 population where the cause was high blood pressure went up from 6.2 in 1999 to 9.0 in 2017.

Over the 1999–2017 study period, 51.3% of those who died of cardiometabolic disease were female, 12.3% were black, and 85.1% were white.

The authors note that during 1999–2017, the age adjusted rates of death "experienced an inflection point in 2010 for deaths due to heart disease, stroke, and diabetes."

The rate of decline in heart disease deaths was faster before 2010 than it was afterward. The rates of decline for deaths to stroke and diabetes flattened after 2010.

Rates of death due to high blood pressure, which rose during 1999–2017, "experienced an inflection point in 2003 and increased less rapidly thereafter."

"Black men consistently had the highest [age adjusted mortality rates] across all underlying causes of death," note the authors.

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Growing obesity the likely culprit

Although they did not examine what could be driving these trends, Dr. Khan suggests that the main culprit is likely to be obesity.

Dr. Khan observes that obesity is a major risk factor for heart disease and that rates of obesity have increased "significantly" since 2011.

First study author Dr. Nilay S. Shah, a cardiology fellow at Northwestern University Feinberg School of Medicine, suggests that not smoking, keeping to a healthy body weight, following a healthful diet, and being physically active are the "cornerstones" of preventing heart disease and maintaining cardiometabolic health.

Dr. Khan emphasizes that it is critical that people begin these actions early in life and ask their doctors to assess risk factors.

U.S. policymakers should develop strategies that help people to eat more healthfully, and that give them places in their neighborhoods where they can exercise safely, she adds. This is in addition to greater access to affordable healthcare and treatments.

"We know the majority of deaths attributable to cardiometabolic disease are preventable."

Dr. Sadiya S. Khan

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