The Health Blog

Coronary heart disease (CHD) is one of the most common causes of excess illness and death in obese people because of the potent combined effects of raised blood pressure, high cholesterol, physical inactivity and type 2 diabetes. Hypertension, myocardial infarction, stroke and congestive cardiac failure are all significantly more common in obesity; left ventricular size and wall thickness increase with BMI because of increased cardiac output. As with other risk factors, abdominal or ‘android’ obesity is associated with higher risk than ‘gynoid’ obesity. The increased levels of LDL cholesterol and triglycerides lead to the enhanced formation of atheromatous plaques in the blood vessels; this factor, combined with the increased coagulability of the blood leads to the increased risk of arterial occlusion. There is a three-fold increase in risk of a fatal or non-fatal MI in women with BMI >29 compared with their leaner counterparts. The Nurses Health study demonstrated similar figures in women: double the risk of CHD in BMI 25-29 and 3.6 times the risk in women with BMI >29. The Framingham study confirms the link between obesity and CHD, and suggests that increasing weight during adulthood might have the greatest impact on CHD; in technical terms, it demonstrated that the risk of heart disease increases by 15% in men and 22% in women for every standard deviation increase in weight.
Although weight loss reduces the risk of heart disease and stroke, the fact that plaque has already been formed and laid down within the arteries suggests that there is likely to still be an increased cardiovascular risk even after weight loss has occurred. The finding of high cholesterol levels and hypertension in obese children as young as 9 has led to the concept of childhood obesity ‘casting a shadow’ on future health, and increasing morbidity and mortality in adulthood, even if the obesity itself is remedied.
*2/312/5*

THE CARBOHYDRATE ADDICTION: CURRENT RESEARCH AT MOUNT SINAI MEDICAL CENTERIn order to explore the effect of food intake on these chemical workings, we have conducted controlled studies of carbohydrate addicts and nonaddicted subjects. We instructed both groups to consume comparable foods during two four-week time periods, with one important difference—during each of the two time periods the distribution of carbohydrates was different.For one period, the carbohydrates were distributed among three meals each day; for the other, the carbohydrates were confined to one meal.We measured the subjects’ experience of hunger and their weight change. The results showed that the frequency of carbohydrate intake affected both the carbohydrate-addicted and nonaddicted group’s experience of hunger and weight. But it affected carbohydrate addicts at a much higher level. Both weight levels and hunger increased in direct proportion to increases in carbohydrate meal frequency. In the carbohydrate addict, these changes showed significant differences when the total daily food intake was the same and only the carbohydrate frequency was changed.In summary, we have found, then, that by consuming only one carbohydrate-rich meal per day, the carbohydrate addict experienced less intense hunger and fewer cravings as well as significantly greater weight loss.This appears to be caused by:Lowered insulin production and/or releaseAn increase in receptor sites (due to the decrease in insulin), with an accompanying increase in the rate at which insulin is removed from the blood
For carbohydrate addicts, this means that by changing the number of times they consume carbohydrates each day, they can reduce the intensity and recurrence of hunger and cravings and increase their body’s tendency to lose weight.
We are pursuing other avenues of research involving triglyceride levels and cholesterol levels in relation to frequency of carbohydrate intake.Our research and that of others indicate that carbohydrate addicts differ greatly in the biological processes that govern their food cravings. Carbohydrate addicts are also different in the ways in which their bodies use and store food energy.Scientists have discovered that these differences in biological processes can make some people predisposed to overweight. These people find themselves craving carbohydrates, and often have difficulty controlling their eating; their bodies may actually, in some sense, be destined to store fat. These processes have been observed in animals that are genetically predisposed toward obesity.The research suggests that, because of their genetic makeup, many overweight people are carbohydrate addicts and have strong, biologically based tendencies to become fat. If their underlying disorders are left untreated, they are equally predestined to remain overweight.At the same time, the evolving body of research reveals a new understanding of the cause of the underlying biological problems, and offers new hope to the carbohydrate addict.*12\236\2*

DEFECTS OF VALVES: DEFECTS IN VALVES ON THE LEFT SIDE OF THE HEART –HOW SERIOUS IS AORTIC REGURGITATION?If you have aortic regurgitation, you can remain free of symptoms for a long time. If the aortic regurgitation is caused by rheumatic fever, symptoms may develop slowly over 10 to 30 years. If it is caused by endocarditis, symptoms may develop much more quickly and be more severe.Paul is a 33-year-old manager of a fast-food franchise who has had a diagnosis of a bicuspid aortic valve since age 19 years, when an echocardiogram was done to evaluate a murmur. Four weeks ago he had three cavities filled. For the past 2 weeks he has felt tired and had a fever on most days, often with chills. During the past 2 days he has become short of breath and cannot lie flat without making the shortness of breath worse. Evaluation confirms the doctor’s impression that he had an infection of the aortic valve and acute aortic regurgitation.Much of the decision-making difficulty associated with mitral regurgitation also applies to aortic regurgitation. You can have minimal symptoms and yet your pumping function can deteriorate to a point that even if the valve is replaced, you may not improve as much as you might have if an operation had been undertaken earlier. However, an operation for even very advanced aortic regurgitation is still likely to yield a good result.*139\252\8*