Inflammation: Is It the New Cholesterol?

In scientific circles, the hypothesis that reducing inflammation can lower the risk of heart disease has been gaining ground. Last weekend, that hypothesis may have finally become fact, with far-reaching implications.

At the European Society of Cardiology meetings in Barcelona, the Novartis-sponsored CANTOS trial demonstrated that an anti-inflammation drug (albeit one that is currently reported to be priced at about $200,000 a year) could reduce the risk of the combination of heart attacks, stroke and death from cardiovascular disease in people who had previously had a heart attack and a blood test that indicated the presence of inflammation. And it did so without affecting cholesterol levels.

The effect on patient care will not be immediate, but the study is transformative in moving inflammation into the category of a modifiable risk factor for heart disease.

What is inflammation? The body’s immune system protects us from foreign invaders, like viruses and bacteria.

Inflammation is the body’s response, with the activation of white blood cells and other substances. Most often, that response helps us. In cancer, scientists have been using our own immune systems to target disease.

However, sometimes, our immune systems can actually attack our own body and cause disease; these are called autoimmune diseases, like rheumatoid arthritis.

Now people are looking at inflammation as contributing to the risk of common conditions, like heart disease.

Paul Ridker, the principal investigator of the CANTOS trial and a cardiologist at Harvard, is the leading proponent of this inflammation hypothesis. [Disclosure: Paul is married to my sister (and I want to disclose that) and so I have had a front row seat in these developments over the last two decades.] His work and that of other scientists carefully and methodically laid the groundwork for the idea that giving people treatment that would quiet their immune systems would reduce their risk of heart disease.

As basic scientists were revealing that inflammation played a role in the biology of the causes of heart disease, clinical scientists were showing that blood tests of inflammation could indicate levels of risk.

People who had a more revved-up immune system had a higher risk of heart disease. And this risk was in addition to what was indicated by traditional risk factors like smoking and high cholesterol levels.

They found that statin drugs, which are highly effective in reducing heart disease risk, actually not only lowered cholesterol, but also calmed inflammation.

And so many speculated that the benefit of statins may also derive from what they do to the immune system.

But the question persisted – could an intervention that targeted the immune system without affecting lipid levels reduce heart disease risk? CANTOS used canakinumab, an expensive drug that is approved for use in some autoimmune diseases, like juvenile arthritis. It targets a particular part of the immune system and can reduce inflammation.

In the study of about 10,000 people who were randomized to receive canakinumab or placebo and followed for 4 years, there was a benefit. For every 1000 people treated with canakinumab, there were about 6 fewer deaths from heart attacks, stroke, or heart disease.

There was also a higher risk of an infection causing death.

There was no difference in deaths from any cause (though the study was not designed to detect a difference in overall deaths).

For patients, this trial is not likely to make canakinumab a household name.

 The benefits were modest, there were some risks, and the price tag, at least now, is in the stratosphere.

But make no mistake, this trial heralds the beginning of a new era in cardiology. It signals that the manipulation of the immune system is likely to be another avenue of reducing cardiovascular risk – and there are many possibilities with new drugs and old ones that could be repurposed.

In fact, the NIH has supported Dr. Ridker to investigate the possibility that methotrexate, an old and inexpensive drug with anti-inflammatory effects, could reduce the risk of heart disease – and that trial, theCardiovascular Inflammation Reduction Trial, according to ClinicalTrials.gov is still recruiting.

And there is something more. In an exploratory analysis that ultimately may or may not turn out to be important, the CANTOS investigators reported that lung cancer rates and deaths were much lower in the canakinumab.

Could such drugs reduce the risk of cancer and heart disease? Could an even safer and less expensive drug do the same thing? This trial should open the gates to an abundance of future research.

The idea that inflammation is important in heart disease is not new and is supported by a mountain of science.

But now we may be at the beginning of translating that science into strategies and interventions. Healthy behaviors continue to be the best way to combat heart disease – but it will be nice to have more tools available and to see this potential unfold in the years ahead.

Source        forbes

Do You Know That:

 

Oxygen is absolutely essential for healthy cells, as it acts against foreign toxins in the body.

Many such toxins, like viruses and bacteria, are mostly anaerobic, (meaning that they thrive in a low-oxygen environment).

And the health researchers at IHMS have just made this possible…

When levels of oxygen increase, the potential for disease decreases. Germs, parasites, fungi, bacteria, and viruses are killed along with diseased and deficient tissue cells.

At the same time, healthy cells not only survive but are better able to multiply.

The result is a stronger immune system and improved overall

immune response.

So you definitely want to ensure that you have sufficient

oxygen in your body.

More Than 10 Percent of World’s Population Is Obese, Study Finds

 

More than 10 percent of the world’s population is now obese, a marked rise over the last 30 years that is leading to widespread health problems and millions of premature deaths, according to a new study, the most comprehensive research done on the subject.

Published Monday in The New England Journal of Medicine, the study showed that the problem had swept the globe, including regions that have historically had food shortages, like Africa.

The study, compiled by the Institute for Health Metrics and Evaluation at the University of Washington and funded by the Gates Foundation, looked at 195 countries, essentially the world’s population, finding that rates of obesity at least doubled in 73 countries — including Turkey, Venezuela and Bhutan — from 1980 to 2015, and “continuously increased in most other countries.”

Analyzing some 1,800 data sets from around the world, researchers found that excess weight played a role in four million deaths in 2015, from heart disease, diabetes, kidney disease and other factors.

The per capita death rate was up 28 percent since 1990 and, notably, 40 percent of the deaths were among people who were overweight but not heavy enough to be classified as obese.

The study defined obese as a body mass index of 30 or higher and overweight as a B.M.I. from 25 to 29.

By those measures, nearly 604 million adults worldwide are obese and 108 million children, the authors reported. Obesity rates among children are rising faster in many countries than among adults.

In the United States, 12.5 percent of children were obese, up from 5 percent in 1980. Combining children and adults, the United States had the dubious distinction of having the largest increase in percentile points of any country, a jump of 16 percentage points to 26.5 percent of the overall population.

A range of nutrition scientists, including ones who differ significantly on some issues in the field, uniformly praised the breadth, depth and quality of the study, and the significance of its message.

“Its global implications are huge,” said Barry Popkin, a professor of nutrition at the University of North Carolina. He echoed others in saying the findings tend to also affirm smaller, more regional studies.

“This study shows what we know: No country in the globe has reduced overweight or obesity levels. This is astounding given the huge health and economic costs linked with overweight and obesity.”

The study largely did not go deeply into the causes of obesity, but the authors said the growing accessibility of inexpensive, nutrient-poor packaged foods was probably a major factor and the general slowdown in physical activity was probably not.

“The change in physical activity preceded the global increase in obesity,” said Dr. Ashkan Afshin, assistant professor at the Institute for Health Metrics and Evaluation and lead author of the study.

“We have more processed food, more energy-dense food, more intense marketing of food products, and these products are more available and more accessible,” he added. “The food environment seems to be the main driver of obesity.”

Others agreed on the availability of poor diet, noting that such food can often be the most accessible and affordable.

“What people eat is the key factor in whether they become obese or not,” said Adam Drewnowsk, director of the Center for Public Health Nutrition at the University of Washington, who was not affiliated with the study, which he deemed “brilliant work by the best people in the business.”

He said getting people healthy food was easier said than done.

“It is all very nice to talk about the need to eat less unhealthy foods and more healthy foods,” he said. But “unhealthy foods cost less; healthier foods often cost more. People eat what they can afford.”

The research characterized growth of obesity in two ways, one that looked at countries that had the biggest leap in percentage points.

After the United States, other countries with particularly significant jumps in percent of the population who are obese included Saudi Arabia, Algeria and Egypt.

But other countries had rates that rose much faster, even though they remained lower as an overall percent of the population. Broadly, the fastest rises were found in Latin America, Africa and China.

In China, for example, less than 1 percent of the population was obesein 1980, but now more than 5 percent is, a fivefold increase. The rise in childhood obesity in China roughly paralleled that overall change.

Three countries in Africa — Burkina Faso, Mali and Guinea-Bissau — had the fastest growth. Burkina Faso, the country with the fastest growth in the world in obesity, began in 1980 with around one-third of a percent of its population as obese. Its rate rose to nearly 7 percent of the population.

“The future health and economic burden facing all these countries is immense,” Dr. Popkin said.

Regarding the overall health implications of the study, one point made by the researchers is that there is a good news/bad news pattern emerging.

The good news is that the disease burden caused by obesity is actually falling in some of the wealthiest nations. In the United States, the death rates associated with obesity fell from 63 per 100,000 in 1990 (the baseline year for this measure) to 61 per 100,000 people, reflecting medications that deal with the effects of obesity, like hypertension.

The bad news is those remedies are not available in developing countries or are available only to the wealthiest people, leading to growing rates of associated deaths and without a clear solution.

“Most of the obese people are dying because of cardiovascular disease and diabetes,” said Dr. Afshin, lead author of the study. That has been somewhat mitigated in the United States “and other developed nations” with the use of drugs.

“But we cannot have all people on drugs,” he said. “Ideally, we want to go to the root causes and address the problem of overeating.”

To date, he said, no country “has been able to control the food environment, which seems to be the main driver of obesity.”

Source         NYTimes

Sitting At One Place For A Long Time Can Kill You

It’s true; sitting on one’s rear end for extended periods is a serious threat to health.

Recent scientific findings suggest prolonged bouts of immobility such as when sitting is being linked to serious diseases that has become epidemic in our society. 

And this is the problem – the human body has been designed to be active – very active and it cannot handle the stress of our modern sedentary behaviors.

You could say we are an immobile lot; in fact we are the most physically inactive population that has ever lived on this planet. We seem to be happiest when we are doing little other than sitting.

After all we sit at work, in the car, on the couch, at the bar, at the movies, on the airplane and watching sport. We sit for hour’s practically comatose watching television, at the computer surfing the internet or playing video games. A screen of any description can hold our interest for hours.

We humans are designed for movement and lots of it. Our evolutionary history has been one characterized by a hunter-gather lifestyle which involved large amounts of vigorous physical activity as we have had to seek out our food from the environment.

This is in direct contrast to modern “easy” and “convenient” lifestyles that most of us now have, where technological advances have removed the need for physical movement almost entirely from our lives. A major part of our modern lifestyle involves sitting and many of us do it for up to 80 percent of our 16 odd waking hours each day.

This is hugely contributing to the fact that many of us are overweight.

But, the human body becoming over-fat is a modern problem – statistics for it did not even exist fifty years ago. But now the incidence of it is pandemic with as many as two-thirds of the population being overweight to some degree or another.

There are several factors that have combined to be the cause – motorized transport, labor saving devises, household appliances along with sedentary jobs where people are sitting all day. Add to that the increase of convenience foods that are energy-dense with high levels of sugars and fats but low in nutrients means we are getting fatter as a greater energy imbalance occurs between calories consumed and calories expended.

Fifty odd years is not long for research and understanding of all of these factors to have been done, so the topic of the rising tide of overweight people in our increasingly sedentary world is of great interest to scientists and researchers. A new science has evolved called “inactivity physiology” investigates the effects of inactivity and sedentary time on our bodies.

Researchers estimate that, thanks to our non-active computerized lives we burn 1,000 fewer calories a day (about half a day’s worth for most of us) than we did just 40 years ago. This is what living a sedentary lifestyle means – it is the type of existence that lacks enough movement and also does not include intentional exercise to give our body’s the muscle building and maintaining activity they must have to remain healthy and well.

It is becoming a global issue and we now have a new kid on the block called Sedentary Death Syndrome which has quickly become the third leading cause of death in the US right after heart disease and cancer.

But the problem is, it is worse that any one single disease as it is actually linked to another 30 odd serious conditions and ailments from diabetes to depression to osteoporosis. The cause of this villain is sitting and is responsible for 2 million deaths worldwide annually.

Thus sitting motionless for long periods creates a problem for us as there is an absence of whole body movement which keeps our body functioning as it is designed to be. This sedentary time leads to a weakening of muscles, bones, heart and lung function along with weight gain as the food we eat is not being used for the energy required for constant physical movement.

Even if the bathroom scales don’t reflect this fat increase it can be hidden deep in the body and muscle loss (from inactivity) hides its presence on the scales.

It does not help that most people mistakenly believe that they get enough activity from the various activities of daily living, such as routines tasks and chores, self-care and light recreational activities. But this amount of physical activity from these non-exercise things  barely counts and is totally off-set by the amount of sitting time most people engage in.

Even if you don’t have a desk job, it doesn’t mean you are off the hook. It’s not only at work where we sit. Typically people sit much more than they even realize – on the couch while watching TV or reading, while eating meals, while getting to and from work (whether driving or riding a bus or train) – to name just a few examples.

Sitting and Your Risk of Disease

One of the major factors the researchers have found to be happening is that the act of sitting down shuts down the circulation of a fat-absorbing enzyme called lipase which has profound negative effects on fat and cholesterol metabolism.

Fat in the bloodstream is normally broken down by this enzyme and then taken up by the muscle cells to be used for energy. But prolonged sitting leaves this fat in the bloodstream to do damage.  After just four hours of sitting and no muscular activity the body starts to send harmful signals and the processing of glucose and fat in the body starts to shut down.

As your body falls deeper into energy-stockpile mode, circulation slows, digestion becomes sluggish and your calorie-burning metabolic furnace dims to a flicker. Glucose and fat in the blood hang around and re-circulate with nowhere to go and end up being stored as excess fat on the belly, hips, thighs and deep inside the body clogging arteries and doing damage to organs and tissues.

It is little wonder that people who sit a lot have two to three times the rates of becoming overweight and susceptible to the killer diseases that are epidemic in the world today. Basically, lack of movement triggers really unhealthy metabolic changes and if you sit in an office chair or on your couch for more than six hours a day then here are some disturbing facts:

Your risk of heart disease has increased by up to 64 percent. You are shaving off seven years of quality life. You are also more at risk for certain types of cancer. Simply put, sitting is killing you.

We may wonder why we allowed ourselves to become so unhealthy.

We know that proper exercise is not only good for us but has now become a matter of life and death. It is not some frivolous pastime that we find time for when we have nothing better to do.

Without enough vigorous physical activity our body has no way of staying healthy. It needs this movement to stimulate the necessary hormones that instruct every cell, tissue, system and process in the human body to repair, rebuild, renew and replace itself.

To save your own life and remain vigorous and healthy you might need to do something that might feel uncomfortable and unnatural, especially at first. You need to move and exert yourself but after you overcome your inertia and do some vigorous activity; you will become aware of the immediate benefits to your mental, physical and emotional well-being. You will also recognize that this was exactly what your body needed.

Don’t let your body deteriorate from lack of use. It’s the only one you get issued with so it makes good sense to do some basic maintenance so it won’t let you down somewhere down the track.

This is such an easy problem to fix. A proper strength training exercise program performed just 2-3 times each week that keeps the muscles strong and healthy is at the top of the list.  Then smaller snatches of activity at regular intervals throughout the day. Simple things like squatting down and up a few times (even beside a desk) will engage the big muscles of the legs and get the circulation of fat burning enzymes pumping again to keep the body healthy.

Instead of looking for opportunities to be seated, look for opportunities to move as much as possible each day.

Too much chair time will kill you – there are no “ifs” or “buts” about it and you will need to move and exert yourself on a regular and consistent basis to offset the damage that is being done to your body by too much sitting.

If you do work seated consider getting a standing or height-adjustable desk. It’s become a trend, so jump on the bandwagon. It’s an easy way to reverse the amount of time sitting each day. Instead of standing as a break from sitting, you can sit when you need a break from standing.

Eventually your body will adjust and it will feel more natural to stand throughout the day. I have been using one for the last 2 years and wouldn’t go back to sitting for long stretches.

The good news is that after you have gotten used to your new found activeness, you will also become more aware of other positive benefits that you will experience. You will begin to recognize that staying strong is exactly what your body needs not only physically but mentally and emotionally as well to be truly healthy and vital.

We each have to take action to avoid becoming one of the millions of people predicted to die of preventable disease in the next decade caused by inactivity. Sitting and living an inactive lifestyle is a dangerous enemy as it is silent and hidden.  But becoming more active will defeat this villain and not only will you look better but you will feel better too.

Combine your strength training program with a satisfying whole-foods nutrition plan that supports your exercise program  and you have the perfect formula for sustaining a healthy slim body for life.

It’s time to throw away all the false statements you’ve accepted about dieting and exercise and learn what it really takes to reshape your body, take weight off and keep it off for good…

Source:          Carolyn Hansen Fitness