Would Weight-Loss Surgery Benefit Diabetics?

When a person becomes obese, the only option he or she can opt for is to lose weight. This is because obesity could lead to many serious medical conditions including Type-2 diabetes, heart disease, high blood pressure and stroke.

Of course, there are several avenues that can help achieve the weight loss.  First of all, he or she should start off with combining a reduction of processed foods high in saturated fats, sugar, salt and caloric content of the diet with an increase in physical activity.

If this fails, which always does, he or she might have to approach the doctors for other means that include use of drugs to decrease appetite, block fat absorption or reduce stomach volume.

Bariatric surgery might be recommended in cases of severe obesity. 2 effective types of bariatric surgical procedures are gastric bypass and gastric banding that can limit intake of food energy by reducing stomach size. 

The FDA (Food and Drug Administration) has approved gastric banding for people with a BMI (Body Mass Index) between 30 and 35 who have an illness linked to obesity. Each year, more than 113,000 bariatric surgeries are performed in the United States. They have saved countless lives but these procedures do carry risks as with any other surgery. As they are complex surgeries, they sometimes result in serious complications. The complication rate for all types of bariatric surgery is about 7.5 percent, according to the National Institutes of Health.

However, a gastric bypass or other type of weight-loss surgery could actually help diabetics who are moderately obese. This was what researchers from the University of California, Los Angeles, Rand Health, VA Greater Los Angeles Healthcare System, Olive View-University of California, and the Akasha Center for Integrative Medicine wrote in their paper that was published on June 5, 2013 in ‘Journal of the American Medical Association’ (JAMA).

Their analysis was based on a review of evidence supporting the use of bariatric surgery to treat people who are diabetic and who have a BMI of between 30 and 35, considered to be on the low end of the obesity spectrum.

Diabetics with moderate obesity were found to lose more weight and had better glucose control over 2 years if they got such surgery rather than opting for non-surgical treatment like dieting and drugs. The researchers also noted that patients who had a gastric bypass achieved better results (more short term weight loss and better control of blood sugar levels) than those who underwent gastric banding.

But since the findings were arrived from a relatively small number of trials, it is necessary to carry out more studies to include on how patients do after 2 or more years, complication rates and side effects. Until then, it is inappropriate to recommend bariatric surgery over nonsurgical weight-loss treatment to people who are obese.

How To Better Predict Stroke In Patients With Atrial Fibrillation?

Atrial fibrillation (or simply AF) is the most common type of arrhythmia, which is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

Though people with AF might not have any symptoms, they are actually at a higher risk of getting a stroke. As AF could lead to the formation of blood clots that can travel to the brain and block an artery, AF independently raises the risk of ischemic stroke 4-to-5-fold. AF could also lead to heart failure and other kinds of heart disease.

Being highly age-dependent, AF affects 10 percent of those aged above 80. About 2.7 million Americans are living with AF.

There is no doubt that predicting ischemic stroke and major bleeding are both relevant to the anticoagulation decision, but previous decision analyses have indicated that risk of ischemic stroke is the more important one for most patients with AF.

In order to help physicians decide whether to begin blood-thinning treatment for patients with AF, a more accurate and reliable stroke prediction model has been jointly developed by researchers from Kaiser Permanente, Massachusetts General Hospital, University of California San Francisco and Stanford University School of Medicine. The findings were published online June 19, 2013 in the ‘Journal of the American Heart Association (JAHA)’. 

To predict AF stroke risk factors, the new model incorporates common clinical features and uses a broader range of age categories to calculate a risk score. The risk score helps doctors and their patients weigh the benefits and risks of starting a blood-thinning treatment.

Clinical features used in the new model include coronary artery disease, diabetes, excess urinary protein excretion, female gender, heart failure, hypertension, kidney dysfunction, peripheral arterial disease, prior ischemic stroke, and older age,

Strong increased stroke risk across the entire age range was found. Individuals aged above 85 were at nearly double the risk of those aged between 75 and 84. But individuals who had experienced a prior stroke were at higher risk regardless of age. Age, prior stroke and their interaction proved to be the dominant risk factors. 

While warfarin (a blood-thinner and anticoagulant) has been known to be highly effective in preventing ischemic stroke, treatment could be difficult to control and often leads to hemorrhage. Based on the prevailing risk assessment formulas recommended by leading clinical practice guidelines, doctors could only have moderate ability to predict which patients will have a stroke.

The new model was effective in calculating risk in primary prevention patients whose stroke risk is most uncertain. These patients pressingly require personalization in the anticoagulation decisions and better prediction in severe stroke.

Laugh More To Be Healthy!

“Laughter can be the best medicine.”

Believe it or not, this is what people always talk about. Is this statement true? If yes, what are the reasons behind such claim?

After years of research, scientists have found some justifications on why laughing is good for the health.  

First of all, laughing boosts the immune system. Laughter has been shown to raise levels of salivary immunoglobulin A (IgA), an important antibody that fights bacteria and infections, especially those in the respiratory system.

Pain could be relieved by laughter, which is effective, free and available everywhere. Endorphins are human body’s natural painkiller that can help ease chronic pain. It is released when people laugh.

Laughing might also increase the tolerance for pain. By watching just 15 minutes of comedy with other people pushed up the pain threshold by about 10 percent, according to a paper published in 2011 in ‘Proceedings Of The Royal Society B: Biological Sciences’ by researchers from the University of Oxford in Britain. Watching drama, factual shows or feel-good nature program, in contrast, did not affect the pain threshold.

Blood sugar levels might be positively affected by laughter, too. In a study, people with Type-2 diabetes and those without diabetes attended a boring lecture after eating a meal. On the next day, the participants joined a comedy show after eating the same meal. The blood glucose levels did not increase after the meal for the diabetic patients at the comedy show. While the researchers have not figured out the exact cause, they suspected that laughter might impact the neuroendocrine system and restrain blood sugar levels from spiking, or cause the acceleration of glucose use by muscle motion.

As shown by studies, laughter could lower or balance blood pressure and increase vascular blood flow. People who lower their blood pressure will reduce their risk of heart attack and stroke. 

By improving blood circulation and increasing oxygenation of the blood, laughter might help fight against heart disease. In a study conducted by the University of Maryland in 2005, laughter was linked to cardiovascular health. The findings found that laughter seemed to cause the endothelium (tissue that composes the lining of blood vessels) to expand and allow for better blood flow.

For those who are unable to do other physical activity due to injury or illness, laughter could be a great cardio workout. Laughing can help the heart pump and burn a similar amount of calories per hour as walking at a slow to moderate pace.

Nevertheless, laughter cannot simply replace medications. Patients should still take the drugs, if any, that are prescribed by their doctors.

Beware Of Heart Disease Even For Youngsters!

Being the number one killer in the United States, heart disease can be prevented with healthy habits for 80 percent of cases, according to the American Heart Association (AHA).

A paper that was published online April 1, 2013 in AHA’s journal ‘Circulation’ revealed that more than 80 percent of the American teens will eventually develop heart disease because of their poor diets: too much fat, salt and sugar, insufficient fruits and vegetables. In addition, they do not exercise enough. Such unhealthy lifestyle is translating into obesity and overweight that will ultimately lead to high blood pressure, high cholesterol and blood glucose at these young ages.

The researchers examined the components of cardiovascular health in 4673 participants aged between 12 and 19 years from the 2005–2010 National Health and Nutrition Examination Surveys. The sample is demographically representative of the 33.2 million adolescents in the United States.

Participants answered questions regarding eating and exercise habits, and they underwent medical examinations too. Their blood pressure, cholesterol and blood sugar levels, as well as weight and diet and exercise habits were recorded. 

Heart disease risk behaviors of participants were ranked according to how well they compiled with the 7 factors that the AHA recently defined as critical for optimal heart health. These factors are maintaining a healthy body weight; eating a healthy diet; being physically active; keeping blood pressure, cholesterol and blood glucose within normal ranges; and not smoking.

Only 45 percent of boys and 50 percent of girls in the study met 5 or more of these criteria, and less than 1 percent of the teens were eating an ideal healthy diet: 4.5 or more cups a day of fruits and vegetables, 2 servings of fish a week, 3 ounces a day of whole grains, less than 1,500 mg of salt a day and no more than 450 calories worth of sugar-sweetened drinks a week.

Regarding physical activity, 44 percent of the girls and 67 percent of boys exercised an hour or more per day, with 13 percent of boys and 23 percent of girls not physically active at all. Meanwhile, 20 percent of boys and 17 percent of girls were found to have a poor body mass index (BMI).

Fortunately, it is possible to reverse the unhealthy trends by using treatments that are neither expensive nor complicated. A lifestyle change, like eating a healthy diet and becoming more active every day, can simply lead to improvements in many of the heart disease risk factors.

5 Symptoms That Could Minimize Damage To Stroke

Being the 4th leading cause of death among Americans, stroke affects about 795,000 people each year in the United States, according to the Centers for Disease Control and Prevention (CDC).

While the elderly used to be the main victims of stroke, approximately 20 percent of stroke cases now occur in people younger than 55 years old. The average age for stroke has declined from 71 to 59 over the past decade.

People can have a stroke when there is an interruption of blood supply to their brain, usually because blood vessel bursts or as a result of blockage by a clot. This would stop supply of oxygen and nutrients, which can cause damage to the brain tissue.

Two main types of stroke are ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when a blood clot or thrombus forms that blocks blood flow to part of the brain while hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures. About 87 percent of stroke cases are Ischemic stroke.

A stroke is a medical emergency and anyone who is suspected of having one should be rush to hospital immediately so that appropriate treatment can be carried out as soon as possible.

There are 5 sudden symptoms of stroke, as brought out by Cedars-Sinai Medical Center, that can save a life, namely sudden numbness or weakness of the face, arm, or leg on one side of the body; sudden confusion, difficulty talking or understanding; sudden trouble seeing on one side; sudden, severe difficulty walking, dizziness, loss of coordination or balance and sudden and severe headache for no known reason.

If any one of these symptoms is recognized, immediate medical help should be sought, regardless of the victim’s age. Any of the severe symptoms could indicate the start of a stroke. Immediate treatment can possibly improve the victim’s chances of not becoming permanently disabled, developing a heart attack or even dying. However, people should not have to worry too much if any of the symptoms just occur in a mild way that lasts for only a short while.

It is possible to prevent a stroke that is in progress with clot-busting drugs and even reverse the damage. According to a study presented at the American Stroke Association's International Stroke Conference 2010, outcome could improve by 30 percent if a stroke patient could take clot-busting drug within 3 hours of onset.

Why Breakfast Should Not Be Skipped?

Breakfast is the first meal and also the most important meal of the day. Studies did unveil that people who skip breakfast might have problems with to concentration, metabolism, weight, and even diabetes.

A study by researchers from Harvard School of Public Health found that men who skip breakfast might face a higher risk of heart attack or deadly heart disease. Their findings were published on July 23, 2013 in the American Heart Disease journal ‘Circulation’.

The researchers assessed in 1992 the eating habits, including breakfast, of 26,902 American men aged between 45 and 82 from the Health Professionals Follow-up Study. These men were free of cardiovascular disease and cancer.

During 16 years of follow-up, 1527 cases of coronary heart disease were diagnosed. After adjustment of demographic, diet, lifestyle, and other coronary heart disease risk factors, it was found that men who skipped breakfast had a 27 percent higher risk of coronary heart disease, compared with men who did not.

Men who did not eat breakfast were found to be on the younger side and more likely to be smokers, employed full time, unmarried, less physically active and drunk more alcohol. These men also did not make up for the lack of food later.

In the prevailing highly competitive environment, people can easily skip breakfast, as they have to rush to work.

But the findings suggested that skipping breakfast might have a significant impact on their health: it could lead to one or more risk factors, including obesity, high blood pressure, high cholesterol and diabetes that might in turn lead to a heart attack over time. 

While 97 percent of men in the study were white and were of European descent, the researchers argued that the results should apply to those of other backgrounds as well. 

Nevertheless, a direct cause and effect relationship between breakfast and health cannot be proven by the study. Though the researchers had taken certain lifestyle factors into account, it could be because of people who take time to have a regular breakfast also tend to have healthier lifestyles.

Can Metabolic Syndrome Be Diagnosed Early?

Metabolic syndrome, which is a disorder of energy utilization and storage, is the name for a group of 5 risk factors that raises one’s risk for many health problems including diabetes, heart disease and stroke. The 5 risk factors are abdominal (central) obesity, high blood pressure, high fasting blood sugar, high triglycerides level, and low high-density lipoprotein (HDL) cholesterol level. When a person is diagnosed with at least 3 out of these 5 risk factors, he or she is said to develop metabolic syndrome.

Because of the rise in obesity rates, metabolic syndrome is becoming more common among adults. It is very likely that it might just overtake smoking as the leading risk factor for heart disease.

At The Endocrine Society's 95th Annual Meeting in San Francisco held on 15-18 June 2013, researchers the University of Virginia, Charlottesville and West Virginia University, Morgantown revealed that they have developed a risk assessment scoring system for diagnosing the metabolic syndrome that might better identify certain adults, especially African Americans, at high risk of developing Type-2 diabetes, heart disease and stroke.

Current diagnostic criteria do not really consider gender and race making some high-risk individuals not meeting the criteria for the metabolic syndrome. For example, African-American men are less likely to be diagnosed with metabolic syndrome, despite having higher rates of Type-2 diabetes and heart disease.

1 in 5 adult in the United States has metabolic syndrome. If the syndrome could be diagnosed earlier, it can begin preventive treatment sooner before development of Type-2 diabetes and occurrence of a heart attack or stroke. 

The study evaluated data from 6,881 men and women participating in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2010. The participants aged between 20 and 64 and were African American, white or Hispanic.

Results of their analysis confirmed that sex- and ethnicity-based differences, which they previously found in teenagers, persist into adulthood. Using this information, they then created a racial- and sex-specific scoring system for the severity of metabolic syndrome. Numeric values were assigned to each of the 5 metabolic syndrome components, with each component having a different weight for each sex and racial-ethnic group.

For women, waist circumference had a higher weighting in blacks than in whites, while the HDL cholesterol level for African-American men received a higher weighting than blood pressure, indicating it may be a more obvious sign of worsening metabolic syndrome.

According to researchers, their new linear scoring system strongly correlated with other biological markers of metabolic risk. Meanwhile, they plan to create online automatic calculators that patients can use to determine their risk score for severity of metabolic syndrome. They also hope that other researchers will use the risk score to determine patients' progress with time, such as improvement in metabolic risk after drug treatment.

Body Fat Is Linked To Heart Disease!

Body mass index (BMI) has been used for decades to determine if a person is overweight or obese, which is linked to development of many chronic diseases including diabetes, heart disease, hypertension and stroke. BMI is calculated by dividing the weight in kilos by the square of height in meters.

People with normal BMI are usually assumed to be healthy though it might not be true. A person with a normal BMI does not necessarily mean that their body’s ability to process fat and sugar is normal. As indicated by some previous research, people with healthy weight might still carry around too much fat.

The latest study by researchers from Dartmouth-Hitchcock Medical Center in the United States found new evidence that suggested older adults with a healthy weight but high percentage of body fat were at higher risk of heart disease and death.

Data of a total of 1,528 people who were 70 years old on average and had a normal BMI were analyzed. It was found that 1 in 5 men and nearly 1 in 3 women had a body fat percentage above what is considered healthy. Excess body fat has been associated with a higher risk of diabetes, hypertension and heart disease.

Meanwhile, a total of 902 of the participants were found dead during the following 13 years, including 419 who died of cardiovascular disease. There were, however, no differences in how often people with high and normal body fat levels died of any cause. High body fat was defined as levels above 25 percent for men and above 35 percent among women.

In the study, women with excess body fat had a 57 percent higher chance of dying from heart disease within 11 years of their assessments than women with a healthy amount of body fat. On the other hand, men with excess body fat were at greater risk of heart-related death after the 11-year mark.

Researchers also found participants with highest body fat were most likely to have hypertension and metabolic syndrome, a cluster of risk factors that will lead to heart disease and diabetes eventually. The findings were published on November 15, 2013 in ‘The American Journal Of Cardiology’. 

Despite of the criticism, BMI has still been used by doctors because it is easy, practical and affordable. There are more high-tech options available for measuring body fat. For instance, a dual-energy X-ray absorptiometry scan that can measure fat levels inside the body. But it costs about US$300, which makes it currently clinically impractical.