Monthly Archives: March 2019

Increasing Glucose Leads to Heart Attacks and Strokes

Today is Diabetes Alert Day, and in recognition our post will review a recently published study on change in fasting glucose levels and subsequent risk of heart attack, stroke and all-cause mortality.

A reasearch group in Korea analyzed data from over 260,000 Korean adults enrolled in the Korean Health Insurance Service. These were adults over 40 years old, and with no diagnosis of diabetes or cardiovascular disease at time of enrollment in the study. The study included both men and women.

At initial enrollment, subjects were divided into two groups- a normal fasting glucose group (glucose <100 mg/dL) and an impaired fasting glucose group (glucose 100-125.9 mg/dL). Data such as smoking status, body mass index, blood pressure, physical activity level, total cholesterol, and alcohol consumption was also collected.

The subjects had a second examination in two years. At this second visit, any changes in fasting glucose between the two visits was noted. On average, these participants were then followed for up to eight years. Data on the number of heart attacks, strokes, and all-cause mortality were collected.

Researchers discovered that those participants who shifted from the normal fasting glucose group into diabetes (glucose >126 mg/dL) were associated with a much higher risk of stroke and all-cause mortality, compared to the participants who remained in the normal glucose group. In addition, those participants initially diagnosed with impaired fasting glucose who later moved into diabetes had a much higher risk of heart attack and all-cause mortality.

The statistics for diabetes are a cause for alarm- it is estimated that the total cost for diabetes in 2017 was $327 billion. About 84 million Americans are currently in the pre-diabetic category, with one of three adults age twenty and older now being pre-diabetic. Given the results of this very robust study, with over two million person-years of follow-up, serious consideration should be given to those interventions which help those who currently have normal or impaired glucose levels from progressing into diabetes.

“No one had ever told me junk food was bad for me. Four years of medical school, and four years of internship and residency, and I never thought anything was wrong with eating sweet rolls and doughnuts, and potatoes, and breads, and sweets.”– Robert Atkins

(Source- Cardiovascular Diabetology (2018) 17:51)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

Poor Dental Health Linked to Increased Risk of Heart Disease in Women

March 20th is World Oral Health Day, and in recognition of this our post today will examine the relationship between periodontitis and cardiovascular disease in post-menopausal women.

Statistics from the CDC indicate that heart disease is the leading cause of death for women in the U.S., accounting for nearly 1 in 4 female deaths. It is estimated that heart disease costs the U.S. about $200 billion annually.

For this study, researchers enrolled 57,000 females from the Women’s Health Initiative Observational Study, between the years 1993-1998. The women were from 40 health centers nationwide, between the ages of 50 to 79. The participants periodontal status was assessed by a questionnaire at five years. There was also annual follow-up through 2010.

Results of the study demonstrated that total mortality risk was significantly higher in women with either edentualism or periodontitis. Also, women who were edentulous had a significantly higher risk of coronary vascular disease and coronary heart disease. These higher risks held even after data was adjusted for potential confounding factors.

This is a very robust study- a large group of post-menopausal women, a cohort that is generally underrepresented in medical research. Given the results of the study, good oral hygiene may be worthy of consideration as a way to potentially lower risk of cardiovascular disease later in life.

On World Oral Health Day, please remember to thank your dentist and hygienist for all their efforts on behalf of your health!

“You don’t have to brush your teeth- just the ones you want to keep.”– Anonymous

(Source- Journal of the American Heart Association, 2017)

This bog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

Good Oral Hygiene May Prevent High Blood Pressure

In recognition of World Oral Health Day on March 20th today’s post will examine the relationship between periodontal disease and prehypertension, as well as hypertension.

According to statistics from the CDC, more than 25% of the adults in the U.S. have untreated tooth decay. In addition, almost half of U.S. adults have some signs of gum disease. Periodontitis is defined as the inflammation of the gums and support structures of the teeth. It is caused by certain bacteria, and in turn these bacteria cause inflammation. It is thought that perhaps if this inflammatory state becomes chronic, it may have implications for inflammation elsewhere in the body, such as in cardiovascular health.

A research group in Japan performed a prospective cohort study on a group of university students, examining whether periodontal disease was related to the development of prehypertension, or to hypertension. Over 2500 students enrolled in the study, ages 18-27 years.

Dentists assessed the oral health of each student. Periodontal health was evaluated using the Community Periodontal Index (CPI), which is commonly used to measure periodontal disease. The CPI is an objective measure of periodontal health, and also suggests the proper treatment for the given CPI score. In addition to the CPI, the dentists also measured the Bleeding Upon Probing (BOP), which is felt to be a simple way to assess inflammation. While dentists assessed oral health, the resting blood pressure and body mass index of the subjects was also measured. The participants also completed a questionnaire, which assessed both dental and general health measures.

The Japanese university students were followed over a period of three years. What the researchers discovered was that the risk of developing hypertension over the three years was significantly associated with periodontal disease.

Given the results of this study, consider practicing good oral health as a way to lower your risk for developing high blood pressure. And don’t forget to thank your dentists and hygienists on World Oral Health Day, or the next time you see them.

“I told my dentist my teeth are going yellow, he told me to wear a brown tie.” – Rodney Dangerfield

(Source- American Journal of Hypertension, March 2016)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

Insomnia Increases Risk of Diabetes

Today is World Sleep Day, and in recognition of this day our post will review recent research regarding insomnia as a risk factor for diabetes mellitus type 2.

The statistics for diabetes are a cause for alarm. According to the American DIabetes Association, over 9% of the U.S. population has diabetes, with 1.5 million new cases diagnosed yearly. Over 84 million Americans are classified as pre-diabetic, and are at high risk for progressing into diabetes. The total cost for diabetes for 2017 was estimated at $327 billion.

A research group in the Portland, Oregon area conducted a retrospective cohort study. The participants numbered over 81,000 and all had been diagnosed with pre-diabetes, and with and without insomnia. On average the subjects were followed over 4 years. The mean age was 57 1/2 years.

What the researchers discovered was that the subjects who had insomnia had nearly a 30% increased risk of developing type 2 diabetes, compared to the group that did not have insomnia, even after adjusting for risk factors such as age, body mass index, and cardiovascular issues.

The mechanism by which insomnia increases the risk of diabetes type 2 is not entirely clear, but may involve activation of the sympathetic nervous system (and hence increased stress hormones), increased inflammation in the body, increased appetite, decreased exercise due to fatigue, or perhaps some other factor. It may well involve multiple factors and not just one.

This study is robust- a large number of subjects were enrolled in a real world clinical setting. It examines a modifiable risk factor for diabetes. Those who have ongoing issues with insomnia may well want to consider the possible implications of developing diabetes from their lack of sleep.

“The worst thing in the world is to try to sleep and not to.” – F. Scott Fitzgerald

(Source- BMJ Open Diabetes Research&Care, 2018)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Eat Your Veggies- Help Your Heart

In recognition of registered dietician nutritionist day, our post today will look at how some dietary factors impact cardiovascular health.

A recent study examined a group of Swedish women and their dietary habits. Nearly 39,000 women completed a 96 item food frequency questionnaire. The questionnaire asked about how certain food or beverages had been consumed over the prior year. Researchers then calculated estimates of the total antioxidant capacity of each respondents diet. Four categories including fruit and vegetable consumption, whole grain consumption, and coffee consumption were used. The participants in the study were followed for approximately ten years. Women in the highest ranking group of total antioxidant capacity of diet, compared to the lowest ranking group, had a 20% lower risk of a heart attack.

This study is an interesting one as it examines a group of women. Women have been typically underrepresented in medical research. This was also a large study of nearly 39,000 subjects, and large is better in this regard.

Finally, which one of us has not encouraged our children to “eat more vegetables”? Now we can add that it is good for their heart as well!

“I eat more vegetables than the average vegetarian.”– Dr. Robert Atkins

(Source- American Journal of Medicine, Vol 125, No. 10, Oct. 2012)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

 

Acupuncture for Insomnia

Insomnia Awareness Day is Monday, March 11th. This is an appropriate designation for the day after Daylight Saving Time begins for the year. In recognition of this day, today’s post will examine the use of acupuncture for primary insomnia.

Insomnia is a common disorder among adults. It is estimated that about 30% of adults have brief periods of insomnia, and upwards of 10% of adults have chronic insomnia, lasting more than three months. It has also been estimated that greater than $60 billion is lost yearly in work production due to insomnia. Insomnia is felt to be a factor in worsening mental health disorders, as well in medical disorders such as hypertension and diabetes mellitus type II.

A recently published study looked at using a short course of acupuncture as an intervention for primary insomnia. 72 subjects with primary insomnia were randomized into either a acupuncture treatment group or a sham (fake) acupuncture group. For the acupuncture treatment group, points were used on the scalp, wrist and lower leg. For the sham acupuncture group the same points were used, but the needle tube was only tapped to give the sensation of a needle being placed. The participants wore eye masks so they could not see whether or not needles were in place.

Participants were treated three times each week, for four weeks. Each treatment session lasted thirty minutes. Questionnaires were filled out every two weeks for a total of eight weeks. The primary outcome measure was the Insomnia Severity Index (ISI). The ISI is a validated assessment tool, consisting of 7 questions, and scored on a scale of 0 (no significant insomnia) to 28 (severe insomnia). The subjects also completed self-rating anxiety and depression scales, to assess their mental health.

Results of the study showed that the Insomnia Severity Index was significantly improved after receiving acupuncture treatment. Sleep efficiency was improved in the acupuncture group beginning at two-weeks post-treatment. Also, sleep awakenings were significantly lower in the acupuncture group, beginning at four weeks post-treatment.

It also appears that acupuncture can improve mental health, as participants in both groups had lower scores on the self-rating scales for both anxiety and depression, compared to baseline scores. It is also important to note that no one withdrew from the study due to some possible adverse side effect from acupuncture.

The study authors did a good job in setting up the sham or placebo acupuncture in a way to keep it blinded to patients. It would be helpful to know how long these beneficial effects of acupuncture on insomnia last, and if there is a certain frequency or schedule that would be optimal. These may be topics of future research.

We have a seemingly low risk treatment for insomnia, that is worthy of consideration. Perhaps consider acupuncture rather than medication for insomnia next time around.

“The best cure for insomnia is to get a lot of sleep.”–  W.C. Fields

(Source- Sleep Medicine 37 (2017), pp. 193-200)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

 

Sauna Good For Mental Health

This is the third and final post in recognition of Helsinki Sauna Day, which is March 9th. We will again look at some of the benefits of sauna baths, this time in the realm of mental health.

The sauna continues to be an important part of Finnish culture. The sauna cuts across socio-economic classes- the prime minister has a sauna at his/her disposal as do most companies. Saunas are felt to be very egalitarian.

This particular study again utilizes the Kuopio Ischemic Heart Disease cohort and is a prospective study. Over 2100 men completed the study, ages 42-61 years. None of the men had any history of psychotic disorders at the time of enrollment. Participants completed a questionnaire that assessed smoking history, use of alcohol, physical activity levels, medical and medication history. The weekly frequency and duration of sauna bathing sessions was also collected. The men were followed for nearly 25 years, on average.

Results of the study showed that frequent sauna bathing is strongly associated with a decreased risk of psychosis, in middle age males.

It would be helpful to carry out a similar study in females. It would also be useful to perform the study amongst a more diverse population, such as we have in the United States.

It is felt that the sauna baths promote relaxation and decrease stress, and perhaps in doing so increase mental health. Saunas are also an opportunity to spend time with friends and family, which also promotes wellness. Given these results, and the low risk nature of sauna bathing, perhaps you may want to consider incorporating this as part of an overall healthy lifestyle.

“A sauna- the poor man’s pharmacy.”–  Finnish Proverb

(Source- Medical Principles and Practice, Sept. 2018)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

Sauna Lowers Risk of High Blood Pressure

This is the second post in recognition of Helsinki Sauna Day, which is March 9th. In this post we will examine research regarding sauna bathing and subsequent development of hypertension.

Sauna is a part of life in Finland, and an important element in Finnish culture. Saunas go back at least 2000 years, and perhaps even much longer. The first saunas were simply dug into embankments, and later free-standing log structures were developed. There are more saunas than cars in FInland.

A prospective cohort study was completed as part of the Kuopio Ischemic Heart Disease Study, this was the same study group that was discussed in our last post. The sample size included over 1600 men, ages from 42 to 60 years. It is important to note that these men did not have high blood pressure at baseline.

The subjects were enrolled in the study between 1984 to 1989. Information such as smoking habits, body mass index, serum creatinine (kidney function), glucose and cholesterol were collected. Sauna bathing habits were assessed via a self-administered questionnaire. The median age was 52.9 years. The average duration of a single sauna session was 14.4 minutes.

The mean time of follow-up was 22 years. During this time, subjects were monitored for the development of hypertension. The researchers discovered that the higher frequency of sauna bathing was independently associated with a lower risk of the development of high blood pressure, in a dose-response manner.

This is an important study- none of the subjects had hypertension when they enrolled into the study. Also, the more sauna sessions a participant had each week, the lower the risk of developing hypertension.

While this study shows impressive results in an all-male study, it should be repeated in a population of female participants to see if the results would still apply. Also, it would be interesting to see if the results would apply in a more diverse population, such as we have in the United States. In any case, taking a sauna bath certainly seems like a low risk endeavour that could potentially lead to the prevention of high blood pressure.

“Build the sauna, then the house.”–  Finnish Saying

(Source- American Journal of Hypertension 30(11), November 2017)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

Sauna Is Good For Your Heart

March 9th is Helsinki Sauna Day, and in recognition of this day our post will review research related to Finnish sauna bathing and cardiovascular events. This will be our first of three posts on the benefits of sauna bathing.

The sauna is an important part of Finnish culture. One of the first recorded writings on sauna baths are from the monk Nestor the Chronicler in 1112. Some versions of the Finnish sauna are thought to go back at least two thousand years. There is an average of one sauna per household in FInland, where saunas are a place to relax with family and friends. A traditional Finnish sauna usually has warm (80-100 C), dry (10-20% humidity) air.

A recent study looked at the association of the frequency as well as duration of sauna bathing and several cardiovascular markers, such as sudden cardiovascular death and fatal cardiovascular diseases. A prospective cohort study was performed by enrolling over 2300 men, ages 42-60 years, from eastern Finland. Subjects were from the Finnish Kuopio Ischemic Heart Disease Risk Factor Study.

The subjects were subdivided into groups based on the frequency of sauna bathing (1, 2-3, and 4-7 times each week) and also the duration of the sauna sessions (<11, 11-19, and >19 minutes per session). Baseline evaluations were conducted beginning in 1984 through 1989. On average, participants were followed for 18.8 years.

Results of the study demonstrated that the subjects with a higher frequency of sauna bathing per week had a lower risk of both fatal coronary heart disease and fatal cardiovascular disease. In fact, the risk of fatal coronary heart disease was 23% lower for 2-3 sauna sessions per week, and 48% lower for 4-7 sauna bathing sessions per week.

In addition, the frequency of sauna bathing was also inversely associated with all-cause mortality, with a 40% reduction in all-cause mortality when comparing 4-7 sessions per week of sauna bathing to one session per week.

The mechanism by which sauna bathing confers these protective cardiovascular benefits is not entirely clear. Heart rate may rise to 100-150 beats per minute during a sauna bath, which is comparable to some types of low and moderate exercise training. It is also believed that sauna bathing is beneficial for the endothelial lining of the blood vessels.

It would be helpful to perform this same study in a population of female participants, to see if the results would be comparable.

While sauna bathing may not be for everyone, again we have a simple low risk intervention that may yield great benefits. Happy Helsinki Sauna Day!

“The ideal sauna is a small building made of logs, set near a lakeshore, facing towards the sunset.”  Bernhard Hillila

(Source- JAMA Internal Medicine 2015: 175(4):542-548)

This bog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.