Cholesterol Screening: How Young is Too Young?

We've all had to do it.  Made an appointment for a physical and had to give blood to check that lipid panel.  What will it be this time...LDL's too high?  HDL's too low?  Triglycerides through the roof (what the heck did I eat last night)?  But do you remember the first time you got your cholesterol checked?  How long should we wait to have our children checked for high cholesterol?  New guidelines from the government may surprise you.

Cholesterol and Triglyceride Tests
Cholesterol and triglyceride tests are blood tests that measure the total amount of fatty substances (cholesterol and triglycerides) in the blood.  Cholesterol travels through the blood attached to a protein. This cholesterol-protein package is called a lipoprotein. Lipoprotein analysis (lipoprotein profile or lipid profile) measures blood levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

• Cholesterol: The body uses cholesterol to help build cells and produce hormones. Too much cholesterol in the blood can build up inside arteries, forming what is known as plaque. Large amounts of plaque increase your chances of having a heart attack or stroke.

• HDL (high-density lipoprotein) helps remove fat from the body by binding with it in the bloodstream and carrying it back to the liver for disposal. It is sometimes called "good" cholesterol. A high level of HDL cholesterol may lower your chances of developing heart disease or stroke.

• LDL (low-density lipoprotein) carries mostly fat and only a small amount of protein from the liver to other parts of the body. It is sometimes called "bad cholesterol." A high LDL cholesterol level may increase your chances of developing heart disease.

• Triglycerides are a type of fat the body uses to store energy and give energy to muscles. Only small amounts are found in the blood. Having a high triglyceride level along with a high LDL cholesterol may increase your chances of having heart disease more than having only a high LDL cholesterol level.

When Are These Tests Done?
Cholesterol testing is normally recommended as a screening test to be done on all adults at least once every five years. It is frequently done in conjunction with a routine physical exam.

Cholesterol is tested at more frequent intervals (often several times per year) in patients who have been prescribed diet and/or drugs to lower their cholesterol. The test is used to track how well these measures are succeeding in lowering cholesterol to desired levels and in turn lowering the risk of developing heart disease.

Cholesterol testing may be ordered more frequently for those who have one or more risk factors for heart disease. Major risk factors include:

• Cigarette smoking
• Age (men 45 years or older or women 55 years or older)
• Hypertension (blood pressure of 140/90 or higher or taking high blood pressure medications)
• Family history of premature heart disease (heart disease in an immediate family member—male relative under age 55 or female relative under age 65)
• Pre-existing heart disease or already having had a heart attack
• Diabetes mellitus

For individuals under 20 years of age and at low risk, cholesterol testing is usually not ordered routinely. However, screening for high cholesterol as part of a lipid profile is recommended for young adults who are at an increased risk of developing heart disease as adults. Some of the risk factors are similar to those in adults and include:

• Family history—history of high cholesterol or heart disease in close relatives, particularly if occurring before age 55 in women or 65 in men. If the family history is not known, a cholesterol test is recommended, especially if other risk factors are present.
• Being overweight or obese—when the young adult’s body mass index (BMI) is at or above the 85th percentile, cholesterol testing is recommended. The BMI should be calculated at least once a year by the young adult’s health care provider. For an obese young adult (one whose BMI is at or above the 95th percentile), laboratory tests to measure cholesterol levels may be recommended every 2 years.
• Consuming excessive amounts of cholesterol, saturated fats, and trans fats
• Diabetes mellitus
• High blood pressure (hypertension)
• Smoking cigarettes 

New Guidelines From the Government:
Every child should be tested for high cholesterol as early as age 9, new guidelines state from an expert panel appointed by the National Heart, Lung, and Blood Institute endorsed by the American Academy of Pediatrics.  This idea will come as a shock to most parents. And it's certain to stir debate.

The rational behind these new guidelines: fat deposits form in the heart arteries in childhood but don't usually harden them and cause symptoms until later in life. The panel urges cholesterol screening between ages 9 and 11 (before puberty) when cholesterol temporarily dips, and again between ages 17 and 21.

Some scary facts that back up this logic:

• By the fourth grade, 10 to 13 percent of U.S. children have high cholesterol, defined as a score of 200 or more.
• Half of children with high cholesterol will also have it as adults, raising their risk of heart disease.
• One third of U.S. children and teens are obese or overweight, which makes high cholesterol and diabetes more likely.

Is This a Good Idea?
These new guidelines would mean mandatory universal cholesterol testing for all children aged 9 and up.  Would finding out a child has high cholesterol really prevent them from suffering from heart disease as an adult?  Another government advisory panel says no.  They state that not enough is known about the possible benefits and risks to recommend for or against cholesterol screening for children and teens.  There must be evidence that treatment improves health, such as preventing heart attacks, rather than just nudging down a number - the cholesterol score.  The guidelines say that cholesterol drugs would be recommended for less than 1% of children tested, and they shouldn't be used in children younger than 10 years of age unless they have severe problems.

What happened to encouraging positive lifestyle choices for children these days?  Are we really so lazy that we are going to pump our kids full of drugs instead of - God forbid - make them play outside for an hour or two each day?  How difficult is it to introduce more fruits and vegetables into childrens diets?  What do I think about this?  I think this never would have been an issue if we took our children's health a little more seriously.

Learn more at:

http://host.madison.com/test/webfeeds/health-treatments/doctors-test-all-kids-for-cholesterol-by-age/article_9e6eb2cb-9bd5-520b-8cd5-e010afda1367.html

Surviving Thanksgiving: Strategies for Before, During, and After the Big Meal

 Countdown to the Typical Food Coma:

Day Before:  

Watch TV and plan how the meal will be scheduled around the football game.

8 a.m.

Eat a big breakfast of eggs, bacon, and hash browns...no work today, there's time to make it hearty!

11 a.m.

Pop in and out of the kitchen and sneak a few bites here and there.

4 p.m.

Thanksgiving Dinner!!

After the Feast:

Lay on the couch with the top button unfastened, watching highlights of the football game.  Have a couple more beers and graze on the leftovers until bedtime.

What Happens to Your Body After a Big Meal?

Every person absorbs fats, sugars, and other nutrients differently.  These certain variations can provide clues about a person's risk for common medical conditions, including heart disease, stroke, and diabetes, research shows.  Even in healthy people, cells that line the blood vessels temporarily function less efficiently after a person eats a high-fat meal.

One of the biggest tasks for the body after consuming a big meal is dealing with those pesky fats in the blood.  Cholesterol, particularly the LDLs, or "bad cholesterol", attacks the walls of the arteries and forms a sticky, plaque-like substance, which can block blood flow or eventually cause the artery to rupture.  This can lead to heart attacks and strokes.  This condition is known as atherosclerosis.

Triglycerides (packaged fat cells in food, the body, and blood), which typically peak after a big meal, are present in food and are also converted by the body from other nutrients, like carbohydrates.  Triglycerides are particularly good at penetrating the artery wall and can further promote atherosclerosis.

Light exercise done continuously for 30 minutes or more appears to reduce the peak in triglycerides that occurs after eating a meal some 12 to 16 hours later.  It is unclear exactly why there is a delay, but exercise induces a number of cellular responses that require different amounts of time to take effect.  Other research has suggested that the benefits of exercise on fat processing can last as long as 48 hours.

Obviously the ideal is to be continuously active.  But if people are more sedentary and want to try to time their exercise for optimal fat processing, it is best to take that long walk about half a day prior to the big meal.

Elevated levels of triglycerides could also be an early warning sign of Type II Diabetes.  People who are insulin resistant, a precursor to Diabetes, also typically have elevated triglyceride levels in the liver, muscle tissue, and blood after eating.

Even in "healthy" people, eating a fatty meal can impair the proper functioning of cells that line the blood vessel, potentially making them more susceptible to atherosclerosis.  The changes to the blood vessel appear specifically triggered by the amount of fat content in the meal.

Reducing the amount of fat in meals can minimize the negative impact on the blood-vessel cells.  Also, scientists expect that eating smaller amounts of food more frequently is better on blood vessels than eating large meals, but research in this area is limited.

Countdown to a Healthier Way to Indulge:

Day Before:

Thirty-minute stroll through the neighborhood.  

8 a.m.:

Ate a healthy breakfast of hot oatmeal with cinnamon and flaxseeds to boost your metabolism.

11 a.m.:

Avoided the temptation to snack in the kitchen.

4 p.m.:

Thanksgiving Dinner!!

After the Feast:

Took another leisurely walk, skipped the late night leftovers, and got back to regular meal sizes and schedules.

Learn more at:

http://online.wsj.com/article/SB10001424052970204517204577046772508688922.html?mod=WSJ_0_0_WZ_Tmpl_Reno_RIGHTTopCarousel_2

The Eating Myths: Who is REALLY Making Us Fat?

Every year the Center for Disease Control (CDC) analyzes data from the national population on our overall health.  As you can see from the trend sheet below Americans are failing, and in a big way.

 What will this look like in the year 2025?  Take a look:

 "Yup"...Fat.  But who should we really be blaming?  Is it our fault we keep getting fatter and fatter, or our environment?  There are three eating myths developed by Brian Wansink, PhD that explain our environment may have more influence on our increasing waistline than people really think.

Eating Myth #1: "Surely something as basic as the size of a bowl wouldn't influence how much an informed, intelligent person eats..."

When looking at the size of plates, bowls, and glasses from thirty years ago to today, its amazing to see how they have changed...to a bigger size, that is.  But does that automatically mean that Americans are eating more?  Can't we monitor how much we actually we put on our enormous plates?  I'm sure we could, but do we?  No.

A study conducted on 150 MBA students in Minnesota shows this.  The students went through 90 minutes of  education on correct portion sizes and what a true serving of carbohyrate, protein, and fat looks like.  All 150 were then invited to a Super Bowl party 6 weeks later at a sports bar.  They were randomly appointed to a room in the bar.  Room 1 had three 4-liter bowls full of Chex Mix; Room 2 had six 2-liter bowls full of Chex Mix, and the bowls were given out to the MBA students upon entering one of the rooms.  They were tested to see how the size of the bowl influenced how much the students ate.  The results?  On average, the students in Room 1 ate 53% more Chex Mix than the students in Room 2.  When asked how full they felt, there was no significant difference in feelings of fullness between the students in each room. 

 OK, but what if we didn't like the food being served?  Would big plates and bowls alone lead us to eat more food even if it was something we didn't necessarily like?

This was tested on 168 moviegoers in Chicago, IL seeing Mel Gibson's "Payback".  Each person was given a free pre-weighed large or extra large popcorn.  Half of the bags contained fresh popcorn and half of the bags contained 5-day-old popcorn, which was stale.  The bags were randomly given out to all 168 moviegoers.  After the movie, the moviegoers were asked how much they thought they ate, and the remaining popcorn was weighed.  Results showed:

• Moviegoers ate 45% more fresh popcorn from the extra large bags than the large ones.
• Even when the bag contained the 5-day-old stale popcorn, moviegoers ate 34% more from the extra large bags than the large ones.

 So, do we overeat the foods we like or do we overeat the foods we have?  Environmental factors may affect how much we eat more than the taste and quality of the food.  Doubling the size of a container causes an 18-25% increase in consumption of meals and 30-45% increase in consumption of snacks

Eating Myth #2: "OK, so people serve more from big bowls and plates and wide glasses.  At least they know when they are full and they can stop before they overeat..."

Say you were given as much of your favorite food as you could ever want.  How much would you eat?  Would you keep eating if your plate never emptied?

That was a question explored by a study cleverly named "The Bottomless Soup Bowl" done on 54 individuals about 11 years ago in the United States.  Half of the participants were given regular 22oz normal soup bowls, and half of the participants were given 22oz soup bowls that were pressure fed underneath the table, that slowly refills as the participant eats out of the bowl.  What did the results find?  Those eating from the bottomless soup bowls unknowingly ate 73% more soup.  Furthermore, those eating from the bottomless soup bowls did not believe they had consumed more or felt more satiety than the others.

Eating Myth #3: "Most of the obesity problem has to do with food eaten away from the home..." 

Americans love to blame the obesity problem on restaurants and their fattening food choices.  But is that really the big issue here?  Should we really only be blaming restaurants for taking our control away?

Take the popular cookbook, The Joy of Cooking, that has numerous editions and has been around for about 75 years.  A study was conducted on each recipe that was found in every edition of The Joy of Cooking, from the first edition to the eighth and final edition.  The amount of calories and serving sizes were analyzed.  What did the results find?  All but one of the repeated recipes increased in calories and serving size.  The average increase in both calories and serving size was 63%.  Two-thirds of the increase was due to the more calorie-dense ingredients, and one-third of the increase was due to the larger serving sizes.  The biggest increases happened in the editions that came out in 1946, 1962, and 2006.

So what can we do?

If we are such mindless eaters, what sort of mindless solutions are out there? It seems our immediate environment causes us to overeat. The mindless solution to that particular problem would be to change our immediate environment to cause us to eat less. How can we do this? Well, the most mindless solution would be to use smaller plates, bowls, and narrow glasses, which will cut down on the amount of calories we take in. It has also been shown that we are more likely to choose to eat what is at eye level in our cupboards and refrigerator. Simply adjusting the eye level foods and rearranging cupboards by putting more nutritious foods at eye level can help "trick" us into eating more healthfully.

 

But which mindless changes work the best? In an experimental pilot study done by Brian Wansink at MindlessEating.org, 2000 volunteers were randomly assigned to make one small, simple change. Examples of changes they were asked to do were replacing wide glasses with thin ones, using only half of their plates for meals, using a salad plate (10-in plate) for a dinner plate, only eating in the kitchen or dining room, etc. There were 20 different changes, with 100 volunteers randomly assigned to each change. Their progress was tracked for 3 months. The results? The volunteers who used a salad plate (10-in plate) for their dinner plates lost an average of 1.97lbs per month. The volunteers who only ate in the kitchen or dining room lost an average of 1.58lbs per month. Surprisingly, chewing gum at times when the volunteer would normally be snacking caused the volunteers to gain an average of 0.62lbs per month, and eating oatmeal as a hot breakfast alternative caused the volunteers to gain an average of 0.83lbs per month. Results indicated that the more "mindless" or convenient the changes were, the more compliant the volunteers were; additionally, there was a 73% correlation between compliance and reported weight loss. For many, the third month (and beyond) had approximately 53% more weight loss than the first. Why would people start losing weight at a higher rate around that third month?

It's the Ripple Effect of one small change.  One small change has been shown to empower a person to make more changes.  Especially if that first change is measurable, achievable, and relevant.  

The power of changing your environment.  It can help change bad eating and snacking habits, and the studies have proven it.  Its so much easier to change your environment than to change your mind.

"The best diet is the diet you don't know your on."

**For more information on the Eating Myths and Mindless Eating, check out  Brian Wansink's MindlessEating.org **

Exercise Essentials: How to Lose That Fat!

This time of year its all about deciding what type of resolution to make for next year.  More exercise?  Healthier diet?  Decrease stress?  What about starting an exercise regimen that targets fat burning?  With a whopping 65% of Americans classified as overweight or obese, that is a very real resolution.  Let's take a look at how easy it can be to formulate an exercise regimen that can be individualized and flexible, but still blast that fat.

There are basically two types of fuel the body uses during exercise: Carbohydrates (glucose) and fat.  Proteins are used to maintain and repair body tissue and are not normally used to power muscle activity.

So how does one naturally increase the body's reliance on fats during exercise over carbohydrates?

Unlike glucose, which can undergo some anaerobic metabolism (generating ATP in muscle cells without oxygen availability), the oxidation of fatty acids is oxygen-dependent.  Therefore, one of the most important factors for fat utilization by skeletal muscle during exercise is oxygen availability.  This begins to explain why there is a decreasing reliance on fat as a fuel for skeletal muscle as intensity increases.  In other words, lower intensity exercise equals higher utilization of fat by the skeletal muscles.  As exercise intensity increases, the skeletal muscle is forced to use anaerobic metabolism to create ATP, because there is no way adequate oxygen can be constantly fed by the bloodstream to the skeletal muscle.  If exercise intensity stays low, the bloodstream has more of an opportunity to keep adequate oxygen needed for aerobic metabolism (generating ATP in muscle cells with oxygen available) in the skeletal muscle.

For the general population, many of whom engage in regular exercise to reduce body fat, it is important to understand the difference between the percentage of fat fuel utilized by the muscles and the absolute quantity of fat used.  Based on the relationship between exercise intensity and fat utilization, low-intensity exercise uses a greater percentage of fat fuel but maximal fat utilization by quantity appears to occur at a moderate intensity.  Exercising above that moderate intensity level increases the use of carbohydrate and decreases the total fat utilization. 

Fat utilization tends to increase throughout the duration of exercise at lower to moderate intensity as well.  The availabilities of glucose, fatty acid, and oxygen at a given time point of the prolonged activity are the most influential factors for which fuel source is utilized by the skeletal muscle.  During the early stages of prolonged exercise, fat contribution to energy expenditure by working skeletal muscle increases slowly.  This has been led to the commonly stated concept that it takes at least 10-15 minutes or so to achieve the "fat-burning zone" associated with exercise.  Then, as exercise continues, the contribution made by fat to fueling muscle contraction can slowly increase, especially if carbohydrate is not consumed during the endurance bout. 

Factors such as level of training and genetic predisposition for muscle content tend to make intensity level of maximal fat use individualized.  Therefore, the "fat-burning zone" often posted on aerobic equipment such as stationary bikes and steppers is presented as a range of associated heart rates.   

What does all of this mean??

If your looking to develop an exercise regimen that will help blast that fat keep two things in mind: 

• Low to moderate intensity

...and...

• Long duration 

Keep in mind that the intensity and duration are very individualized and numbers vary from person to person.  It is important to develop your own pace and length that works for you.  There is no cookie-cutter magic number that works for everyone.  Don't get discouraged, keep trying and don't give up!! 

Refreshing Coconut Vanilla Mint Smoothie

Perfect for a Postworkout Snack!

8 coconut ice cubes*
4 ice cubes
1 cup lowfat vanilla yogurt
4-5 fresh mint leaves
1 scoop (1-2 Tbsp) vanilla whey protein

Put all ingredients into a blender and blend until smooth.  Add some water if needed.  Enjoy with another mint leaf and a bit of shaved coconut on top!

*To make coconut ice cubes, pour coconut water (not coconut milk) into an ice tray and freeze overnight.

Food and Eating: Who is in Control?

You get home from a long, hectic day at work and immediately go to the kitchen.  You reach for that bag of yummy potato chips, grab a handful and munch away, mindlessly.  A half an hour later you realize the entire bag is gone, along with a row of Oreo cookies and a couple of pieces of cheese.  How many times has this happened to you?  And when or if it does, how much control do you actually have over your eating, and how much do your emotions come into play?

Studies show that as humans we are born with an innate ability to control the amount of calories we consume and we automatically know when to stop eating.  This ability has been shown to be extremely individualized and follows the personal growth curve each of us has when we are born.  Genetics play a huge part in this and we are already predisposed to the body type that our DNA encodes.  But if we were born with this innate ability, why do we see an estimated 65% of Americans currently overweight or obese?  This innate ability to control our individualized caloric needs seems to disappear as we get older, and it may be due to our "obesogenic" environment.

Our surroundings constantly bombard us with genius marketing ploys to get us to eat that Big Box from Taco Bell at 1am, or tell us we just can't live without that last doughnut from Krispy Kreme.

But what is really telling us to eat those thousands of empty calories as we graze throughout the day?  Our physical hunger or our emotions?

Say that it is physical hunger.  Take a look at the example at the top once again: you get home from work and immediately start the grazing routine before dinner.  If physical hunger is the issue, then there has been an inadequate amount of calories consumed throughout the day.  For many professionals skipping breakfast to get to that early morning meeting or blowing off lunch to get that extra proposal done is a common practice and often leads to the grazing binge in the evening.  Each and every one of us has a certain amount of calories  that need to be consumed daily, and it is important to spread those out throughout the day in three meals and a couple of snacks to make sure our bodies are being fueled appropriately.  Being physically hungry is not a particularly enjoyable experience, and that feeling in itself can be emotional and stressful.  This can then turn into an uncontrollable binging session fueled more by emotion than pure physical hunger.

Let's say its emotional eating, again looking at the top example.  Maybe the day was extremely stressful due to your work, family, or social life.  Eating has been recognized as a coping mechanism for dealing with stress and emotion for many individuals, and in our culture it is easy to overindulge on calorically dense food items.  Eating can be a way to distract us from our real emotions and what we are actually feeling.  And because it tastes good and gives a sense of satiety, it can make this practice of covering up emotions pleasant and enjoyable.  Pretty soon, you are coming home from work stressed and emotional 5 days per week and binging to elevate your mood.  Think of all those empty calories!!

 So What Can We Do To Help Prevent This?

1.) Make sure you are getting the appropriate number of calories per day, plus or minus 200.

An easy way to figure out how many calories you should be consuming is an easy calculation:

Women:
a.) Divide your weight in pounds by 2.2

b.) Multiply your height in inches by 2.54

c.) Multiply the result in step a.) by 9.6

d.) Multiply the result in step b.) by 1.7

e.) Multiply your age by 4.7

f.) Now add the results of steps c.) and d.).  Subtract the result from step e.) from that sum.  Now add 655.

Men:
a.) Divide your weight in pounds by 2.2

b.) Multiply your height in inches by 2.54

c.) Multiply the result in step a.) by 13.8

d.) Multiply the result in step b.) by 5

e.) Multiply your age by 6.8

f.) Now add the results of steps c.) and d.).  Subtract the result from step e.) from that sum.  Now add 66.5. 

This is your resting metabolic rate, and the amount of calories needed to maintain your body at rest.  Most individuals would need to multiply this by 1.3 to 1.5 to get the amount of calories needed to maintain your body at rest and including physical activity.

2.) Slow down the pace of eating.

It takes your stomach approximately 20 minutes to tell your brain that your full and to stop eating any more.  Eating fast will not give the appropriate time your body needs to send signals from your stomach to your brain and will cause you to overeat as a result.  Try taking breaks during between bites and taking more time while chewing.  This can also encourage more of a social opportunity while eating and you can engage in conversation a bit more easily.

3.) Choosing to eat food that is both nourishing and pleasing

Being able to please your senses while nourish your body can take away from the negative aspects of emotional eating.  Think how great it could be if your favorite junk food that you love to indulge on was also as nutritious as two servings of vegetables!  

4.) Eating away from distractions

Eating in front of the television or in the car is just another distraction that can further cause a mindless binge.  Try to eat with other individuals you enjoy and can have conversations with.  This will help you enjoy eating more, but not because of the food you put in your mouth, but more as a result of the experience of eating.

5.) Be mindful!!

Ask yourself if there are other ways of meeting the need that eating might fulfill at that time? Is there something you could do for yourself that might even fulfill your need better than food? Are you stressed after a long workday? Would a hot bath or “zoning out” in front of the TV help relax you just as well, or better? If so, try it and see if it works.

Never forget that you do not have to be perfect. Whatever you finally choose, move on with life and keep a positive attitude!

This blog post was inspired by Kim Flannery, RD