Cannabis use linked to increase in heart attack and stroke risk

 

Research Highlights:

• An analysis of survey data for 430,000 adults in the U.S. found that using cannabis has a significant association with an increased risk of heart attack and stroke, independent of tobacco use, with higher odds among the adults with more frequent use (more days of use per month). The most common method of cannabis use was smoking, followed by eating or vaporizing it.
• The increase in the combined risk of coronary heart disease, heart attack and stroke was similar to the risk among the subset of adults who had never used e-cigarettes but did use cannabis.

An analysis of 430,000 adults in the U.S. found that using cannabis, most commonly through smoking, eating or vaporizing it, was significantly associated with a higher risk of heart attack and stroke, even after controlling for tobacco use (combustible cigarettes and other tobacco products) and other cardiovascular risk factors, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Although cannabis, or marijuana, is illegal at the federal level, 24 states and Washington, D.C., have legalized the use of recreational cannabis. Additionally, the number of people in the U.S. who use cannabis has increased significantly in recent decades, according to the 2019 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. The annual survey found that in 2019, 48.2 million people ages 12 or older reported using cannabis at least once, compared to 25.8 million people ages 12 or older in 2002, an increase to 17% from 11%.

“Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks,” said lead study author Abra Jeffers, Ph.D., a data analyst at Massachusetts General Hospital in Boston. “The perceptions of the harmfulness of smoking cannabis are decreasing, and people have not considered cannabis use dangerous to their health. However, previous research suggested that cannabis could be associated with cardiovascular disease. In addition, smoking cannabis—the predominant method of use—may pose additional risks because particulate matter is inhaled.”

In this study, researchers reviewed survey data collected for 430,000 adults from 2016 through 2020 to examine the association between cannabis use and adverse cardiovascular outcomes including heart disease, heart attack and stroke. The survey data was collected through the Behavioral Risk Factor Surveillance System, a national, cross-sectional survey performed annually by the U.S. Centers for Disease Control and Prevention.

The researchers specifically investigated whether cannabis use was associated with adverse cardiovascular outcomes among the general adult population, among people who had never smoked tobacco or used e-cigarettes, and among younger adults (defined as men under age 55 and women under age 65) at risk for heart disease. They also factored in the number of days per month that people used cannabis.

The analyses of found:

• Any cannabis use (smoked, eaten or vaporized) was independently associated with a higher number of adverse cardiovascular outcomes (coronary heart disease, myocardial infarction and stroke) and with more frequent use (more days per month), the odds of adverse outcomes were even higher. The results were similar after controlling for other cardiovascular risk factors, including tobacco and/or e-cigarette use, alcohol consumption, body mass index, Type 2 diabetes and physical activity.
• Both daily and non-daily cannabis users had an increased risk of heart attack compared to non-users; daily cannabis users had 25% higher odds of heart attack compared to non-users.
• The odds of stroke for daily cannabis users were 42% higher compared to non-users, with lower risk among those who used cannabis less than daily.
• Among younger adults at risk for premature cardiovascular disease (defined as men younger than 55 years old and women younger than 65 years old) cannabis use was significantly associated with 36% higher combined odds of coronary heart disease, heart attack and stroke, regardless of whether or not they also used traditional tobacco products. A separate analysis of a smaller subgroup of these adults who had never smoked tobacco cigarettes or used nicotine e-cigarettes also found a significant association between cannabis use and an increase in the combined odds of coronary heart disease, heart attack and stroke.

“Our sample was large enough that we could investigate the association of cannabis use with cardiovascular outcomes among adults who had never used tobacco cigarettes or e-cigarettes,” Jeffers said. “Cannabis smoke is not all that different from tobacco smoke, except for the psychoactive drug: THC vs. nicotine. Our study shows that smoking cannabis has significant cardiovascular risk risks, just like smoking tobacco. This is particularly important because cannabis use is increasing, and conventional tobacco use is decreasing.”

Study background and details:

• Survey participants were ages 18-74, with an average age of 45 years.
• About half of the participants self-identified as female. 60.2% self-identified as white adults, 11.6 self-identified as Black adults, 19.3 self-identified as Hispanic adults and 8.9% self-identified as other.
• Nearly 90% of adults did not use cannabis at all; 7% used it less than daily; and 4% were daily users. Among current cannabis users, 73.8% reported smoking as the most common form of cannabis consumption. More than 60% of total respondents had never used tobacco cigarettes; 28.6% of daily cannabis users had never used tobacco cigarettes; 44.6% of non-daily cannabis users had never used tobacco cigarettes and 63.9% of participants who did not use cannabis had never used tobacco cigarettes.

The study had several limitations, including that cardiovascular conditions and cannabis use were self-reported, making them potentially subject to recall bias (potential errors in memory); that the authors did not have health data measuring participants’ baseline lipid profile or blood pressure; and the study captured data for only a single point in time for the participants. The authors note that there is a need for prospective cohort studies – studies that follow groups of individuals over time – to examine the association of cannabis use and cardiovascular outcomes while accounting for frequency of cannabis use.

“The findings of this study have very important implications for population health and should be a call to action for all practitioners, as this study adds to the growing literature that cannabis use and cardiovascular disease may be a potentially hazardous combination,” said Robert L. Page II, Pharm.D., M.S.P.H., FAHA, chair of the volunteer writing group for the 2020 American Heart Association Scientific Statement: Medical Marijuana, Recreational Cannabis, and Cardiovascular Health. Page is professor of clinical pharmacy, medicine and physical medicine at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado School of Medicine in Aurora, Colorado. Page was not involved in this study.

“In the overall population, the study findings are consistent with other studies indicating that daily cannabis use was associated with an increase in heart attack, stroke and the combined endpoint of coronary heart disease, heart attack and stroke,” he said. “As cannabis use continues to grow in legality and access across the U.S., practitioners and clinicians need to remember to assess cannabis use at each patient encounter in order to have a non-judgmental, shared decision conversation about potential cardiovascular risks and ways to reduce those risks.”

Co-authors, disclosures and funding sources are listed in the manuscript.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/cannabis-use-linked-to-increase-in-heart-attack-and-stroke-risk?preview=e919e005254fa47b47399df04824aaf0
• After February 28, view the manuscript online.
• AHA news release: Marijuana use linked with increased risk of heart attack, heart failure (November 2023)
• AHA news release: The 411 on marijuana use and cardiovascular health ahead of 4/20 Day (April 2023)
• Follow AHA/ASA news on X (formerly known as Twitter) @HeartNews
• Follow news from the Journal of the American Heart Association @JAHA_AHA
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Ultra-processed food: 30 damaging health outcomes

Consistent evidence shows that higher exposure to ultra-processed foods is associated with an increased risk of 32 damaging health outcomes including cancer, major heart and lung conditions, mental health disorders, and early death.

The findings, published by The BMJ today, show that diets high in ultra-processed food may be harmful to many body systems and underscore the need for urgent measures that target and aim to reduce dietary exposure to these products and better understand the mechanisms linking them to poor health.

Ultra-processed foods, including packaged baked goods and snacks, fizzy drinks, sugary cereals, and ready-to-eat or heat products, undergo multiple industrial processes and often contain colours, emulsifiers, flavours, and other additives. These products also tend to be high in added sugar, fat, and/or salt, but are low in vitamins and fibre.

They can account for up to 58% of total daily energy intake in some high income countries, and have rapidly increased in many low and middle income nations in recent decades.

Many previous studies and meta-analyses have linked highly processed food to poor health, but no comprehensive review has yet provided a broad assessment of the evidence in this area.

To bridge this gap, researchers carried out an umbrella review (a high-level evidence summary) of 45 distinct pooled meta-analyses from 14 review articles associating ultra-processed foods with adverse health outcomes.

The review articles were all published in the past three years and involved almost 10 million participants. None were funded by companies involved in the production of ultra-processed foods.

Estimates of exposure to ultra-processed foods were obtained from a combination of food frequency questionnaires, 24 hour dietary recalls, and dietary history and were measured as higher versus lower consumption, additional servings per day, or a 10% increment.

The researchers graded the evidence as convincing, highly suggestive, suggestive, weak, or no evidence. They also assessed the quality of evidence as high, moderate, low, or very low.

Overall, the results show that higher exposure to ultra-processed foods was consistently associated with an increased risk of 32 adverse health outcomes.

Convincing evidence showed that higher ultra-processed food intake was associated with around a 50% increased risk of cardiovascular disease related death, a 48-53% higher risk of anxiety and common mental disorders, and a 12% greater risk of type 2 diabetes.

Highly suggestive evidence also indicated that higher ultra-processed food intake was associated with a 21% greater risk of death from any cause, a 40-66% increased risk of heart disease related death, obesity, type 2 diabetes, and sleep problems, and a 22% increased risk of depression.

Evidence for the associations of ultra-processed food exposure with asthma, gastrointestinal health, some cancers and cardiometabolic risk factors, such as high blood fats and low levels of ‘good’ cholesterol, remains limited.

The researchers acknowledge that umbrella reviews can only provide high-level overviews and they can’t rule out the possibility that other unmeasured factors and variations in assessing ultra-processed food intake may have influenced their results.

However, their use of rigorous and prespecified systematic methods to evaluate the credibility and quality of the analyses suggests that the results withstand scrutiny. 

As such, they conclude: “These findings support urgent mechanistic research and public health actions that seek to target and minimise ultra-processed food consumption for improved population health.”

Ultra-processed foods damage health and shorten life, say researchers in a linked editorial. So what can be done to control and reduce their production and consumption, which is rising worldwide?

They point out that reformulation does not eliminate harm, and profitability discourages manufacturers from switching to make nutritious foods, so public policies and action on ultra-processed foods are essential. 

These include front-of-pack labels, restricting advertising and prohibiting sales in or near schools and hospitals, and fiscal and other measures that make unprocessed or minimally processed foods and freshly prepared meals as accessible and available as, and cheaper than, ultra-processed foods.  

It is now time for United Nations agencies, with member states, to develop and implement a framework convention on ultra-processed foods similar to the framework on tobacco, and promote examples of best practice, they write.

Finally, they say multidisciplinary investigations “are needed to identify the most effective ways to control and reduce ultra-processing and to quantify and track the cost-benefits and other effects of all such policies and actions on human health and welfare, society, culture, employment, and the environment.”

Yoga provides unique cognitive benefits to older women at risk of Alzheimer’s disease

 

A new UCLA Health study found Kundalini yoga provided several benefits to cognition and memory for older women at risk of developing Alzheimer’s disease including restoring neural pathways, preventing brain matter decline and reversing aging and inflammation-associated biomarkers – improvements not seen in a group who received standard memory training exercises. 

The findings, published in the journal Translational Psychiatry, are the latest in a series of studies led by UCLA Health researchers over the past 15 years into the comparative effects of yoga and traditional memory enhancement training on slowing cognitive decline and addressing other risk factors of dementia.  

Led by UCLA Health psychiatrist Dr. Helen Lavretsky of the Jane and Terry Semel Institute for Neuroscience and Human Behavior, this latest study sought to determine whether Kundalini yoga could be used early on to prevent cognitive decline and trajectories of Alzheimer’s disease among postmenopausal women. 

Women have about twice the risk of developing Alzheimer’s disease compared to men due to several factors including longer life expectancy, changes in estrogen levels during menopause and genetics. 

In the new study, a group of more than 60 women ages 50 and older who had self-reported memory issues and cerebrovascular risk factors were recruited from a UCLA cardiology clinic. The women were divided evenly into two groups. The first group participated in weekly Kundalini yoga sessions for 12 weeks while the other one group underwent weekly memory enhancement training during the same time period. Participants were also provided daily homework assignments. 

Kundalini yoga is a method that focuses on meditation and breath work more so than physical poses. Memory enhancement training developed by the UCLA Longevity center includes a variety of exercises, such as using stories to remember items on a list or organizing items on a grocery list, to help preserve or improve long-term memory of patients. 

Researchers assessed the women’s cognition, subjective memory, depression and anxiety after the first 12 weeks and again 12 weeks later to determine how stable any improvements were. Blood samples were also taken to test for gene expression of aging markers and for molecules associated with inflammation, which are contributing factors to Alzheimer’s disease. A handful of patients were also assessed with MRIs to study changes in brain matter. 

Researchers found the Kundalini yoga group participants saw several improvements not experienced by the memory enhancement training group. These included significant improvement in subjective memory complaints, prevention in brain matter declines, increased connectivity in the hippocampus which manages stress-related memories, and improvement in the peripheral cytokines and gene expression of anti-inflammatory and anti-aging molecules. 

“That is what yoga is good for -- to reduce stress, to improve brain health, subjective memory performance and reduce inflammation and improve neuroplasticity,” Lavretsky said. 

Among the memory enhancement training group, the main improvements were found to be in the participants’ long-term memory.  

Neither group saw changes in anxiety, depression, stress or resilience, though Lavretsky stated this is likely because the participants were relatively healthy and were not depressed. 

While the long-term effects of Kundalini yoga on preventing or delaying Alzheimer’s disease require further study, Lavretsky said the study demonstrates that using yoga and memory training in tandem could provide more comprehensive benefits to the cognition of older women. 

“Ideally, people should do both because they do train different parts of the brain and have different overall health effects,” Lavretsky said. “Yoga has this anti-inflammatory, stress-reducing, anti-aging neuroplastic brain effect which would be complimentary to memory training.”   

Talking faster is linked to better brain health as we age

As we get older, we may start to notice it takes us longer to find the right words. This can lead to concerns about cognitive decline and dementia.

However, a new study by Baycrest and the University of Toronto suggests that talking speed is a more important indicator of brain health than difficulty finding words, which appears to be a normal part of aging. This is one of the first studies to look at both differences in natural speech and brain health among healthy adults.

“Our results indicate that changes in general talking speed may reflect changes in the brain,” says Dr. Jed Meltzer, Baycrest’s Canada Research Chair in Interventional Cognitive Neuroscience and the lead author on this study. “This suggests that talking speed should be tested as part of standard cognitive assessments to help clinicians detect cognitive decline faster and help older adults support their brain health as they age.”

In this study, 125 healthy volunteers aged 18 to 90 completed three different assessments. The first was a picture-naming game, in which they had to answer questions about pictures while ignoring distracting words they heard through headphones. For example, when looking at a picture of a mop, they might be asked, “Does it end in ‘p’?” while hearing the word “broom” as a distraction. In this way, the researchers were able to test the participants’ ability to recognize what the picture was and to recall its name.

Next, participants were recorded as they described two complex pictures for 60 seconds each. Their language performance was then analyzed using Artificial Intelligence-based software, in partnership with Winterlight Labs. Among other things, researchers examined how fast each participant spoke and how much they paused.

Finally, the research participants completed standard tests to assess mental abilities that tend to decline with age and are linked to dementia risk – namely, executive function, which is the ability to manage conflicting information, stay focused and avoid distractions.

As expected, many abilities declined with age, including word finding speed. Surprisingly, although the ability to recognize a picture and recall its name both worsened with age, this was not associated with a decline in other mental abilities. The number and length of pauses participants took to find words was not linked to brain health. Instead, how fast participants were able to name pictures predicted how fast they spoke in general, and both were linked to executive function. In other words, it wasn’t pausing to find words that showed the strongest link to brain health, but the speed of speech surrounding pauses.

Although many older adults are concerned about their need to pause to search for words, these results suggest this is a normal part of aging. On the other hand, slowing down of normal speech, regardless of pausing, may be a more important indicator of changes to brain health.

In future studies, the research team could conduct the same tests with a group of participants over several years, to examine whether speed speech is truly predictive of brain health for individuals as they age. In turn, these results could support the development of tools to detect cognitive decline as early as possible, allowing clinicians to prescribe interventions to help patients maintain or even improve their brain health as they age.

Ginseng speeds up recovery and reduces muscle fatigue after exercise

 

Ginseng is one of the most popular food supplements in the world. It is made out of various plants and herbs and is thought to provide many benefits, with numerous studies pointing at possible anti-inflammatory and antioxidant benefits as well as anti-cancer effects. A group of researchers at the Universitat Oberta de Catalunya (UOC) has now found that it can also be helpful for exercise.

 

According to the findings of the study, which was carried out as part of a master's degree final project and was recently published in the open-access journal Nutrients, taking ginseng has a direct effect on reducing fatigue and helps muscles to recover after sport.

 

"We've found that ginseng can play a significant role as a nutritional supplement when it comes to recovering after exercise," said Borja Muñoz, a fitness coach and one of the study's lead authors, who has conducted this research under the supervision of his tutor Patricia Martínez, a dietician and nutritionist and course instructor at the UOC's Faculty of Health Sciences, together with the experts Rafael Bailón and Laura Esquius, a researcher at the UOC's Foodlab group. To carry out the study, they systematically reviewed over 700 articles from the scientific literature and meticulously analysed their findings to confirm these benefits for healthy adults engaging in physical exercise.

 

"When taken together with a balanced diet, ginseng can provide additional nutrition for athletes or anyone else who does physical exercise on a regular basis. It's also worth noting that, unless it's medically contraindicated in any given case, taking ginseng on a regular basis is considered beneficial (or at least not harmful) for healthy people," said Muñoz.

 

Evidence and benefits of ginseng

 

The review has concluded that taking ginseng can significantly reduce post-exercise muscle damage in healthy adults. Furthermore, it improves muscle regeneration and helps the body recover from both muscle fatigue and damage after physical exercise.

 

Specifically, the exertion and intensity involved in sport result in damage to muscles. This is mainly inflammatory damage. The active ingredients of the compounds contained in ginseng stimulate the central nervous system, have antioxidant and anti-inflammatory properties and regulate cortisol, the stress hormone, benefiting many of the body's metabolic functions and helping the immune system perform as it should.

 

Specifically, taking ginseng systematically for a long time can mitigate the response of the biological markers, mainly creatine kinase (CK) and interleukin 6 (IL-6), responsible for exercise-induced muscle damage and inflammation. Furthermore, it reduces and mitigates the appearance of lactate in the blood. Lactate is a chemical compound produced by the body when muscles have insufficient oxygen due to overexertion that hinders muscles' ability to contract, the main cause of muscle fatigue.

 

Potential to reduce the risk of injury

 

It should also be noted that, by reducing fatigue, taking ginseng on a regular basis may also help reduce the risk of injury, particularly in the case of muscles or ligaments, which can in turn improve athletic performance.

 

"Although recovery times vary based on the nature of the injury and between individuals, the damaged structures share the same physiological processes. That's why professionals in this field must obtain the most efficient physiological context, to ensure that each person can recover as well and as quickly as possible. This is where ginseng comes in, as it can play a significant role in recovering from injuries," said Muñoz about the possible benefits to athletes, based on their own personal characteristics, of taking ginseng according to a schedule.

 

A common product in traditional Chinese medicine

 

The study arose from Muñoz's interest in confirming by means of scientific evidence the empirical experiences observed by him when doing work experience as a fitness coach and injury specialist in a football club in China. Muñoz observed that ginseng, a supplement very commonly used in traditional Chinese medicine, was widely used by football players, who reported beneficial effects from taking it.

 

"Our aim was to learn more about the effects of ginseng in a specific situation, in this case in connection with exercise, and to provide verifiable evidence of its ability to improve the body's response to the stimuli of chronic load in sport, helping athletes to recover between training sessions, as the footballers themselves reported that it worked just like an energy drink," said Muñoz.  In fact, there are currently countless products for athletes on the market, such as tablets and specific drinks.

 

Establishing a scheduled consumption protocol for the future

 

According to these experts, this may pave the way for studying the benefits of ginseng in greater depth and assessing how using it as a supplement can improve performance in sport. In fact, one of its main possible effects is stimulating and speeding up the body's regeneration processes following muscle damage.

 

"Of the possible future research we're considering, a study to establish a scheduled consumption protocol to find out exactly how and when athletes should take ginseng to optimize its benefits within a given timeframe is particularly appealing, as the studies carried out in relation to these cases suffer from a lack of diversity and scientific evidence," said Martínez.

 

The authors stressed in this regard that the methodology to be used in each type of situation must be clarified in order to learn more about how to improve supplementation with ginseng. "There's still a significant amount of work to do, as ginseng has potential to increase athletes' physical performance and help prevent certain injuries, particularly muscle injuries," concluded Muñoz.

Establish regular healthy sleeping patterns

t’s official. Getting the recommended 7-9 hours of sleep a night is currently out of reach for almost one-third of the population as Flinders University experts found 31% of adults had average sleep durations outside the recommended range.

The global study of thousands of adults published in Sleep Health found only 15% of people slept the recommended 7-9 hours for five or more nights per week – and among those who did achieve an average of 7-9 hours per night over the nine month monitoring period, about 40% of the nights fell outside the ideal range.

“This is crucial because regularly not sleeping enough – or possibly too much – are associated with ill effects and we are only just realising the consequences of irregular sleep,” says Flinders University researcher Dr Hannah Scott.

“Clearly getting the recommended sleep duration range frequently is a challenge for many people to achieve, especially during the working week.” 

The Flinders research group used sleep tracker data collected by an under-mattress sensor to examine sleep durations over the nine-month period in almost 68,000 adults worldwide. The sample consisted of 67,254 adults (52,523 males, 14,731 females), mainly in Europe and North America, whose sleep recordings were registered by the Withings under-mattress Sleep Analyzer. 

Sleeping less than six hours on average per night is associated with increased mortality risk and multiple health conditions including hypertension, obesity and heart disease. Less than 7 hours and more than 9 hours of sleep a day has been linked to adverse health and wellbeing, including digestive and neuro-behavioural deficits. 

Female participants generally had longer sleep durations that males, and middle-aged people recorded shorter sleep durations than younger or older participants.

“Based on these findings, public health and advocacy efforts need to support the community and individuals to achieve more regular sleep within the recommended range for their age,” says co-author Professor Danny Eckert, an Australian National Health and Medical Research Council (NHMRC) leadership fellow and director of Sleep Health research at Flinders University.

“Given what we know about the importance of sleep to health, we also need to assist people to resolve chronic sleep difficulties and encourage all people to make sleep a priority.”

Regular snoring is also associated with hypertension, according to another new study from Flinders University.

The Flinders sleep researchers’ tips to achieve a better sleep regime include:

• In the short term, people are advised to try and maintain a sleep schedule that is sufficient for them to feel rested enough, as often as they possibly can. Keeping a fixed wake-up time, even on weekends, and going to bed when you feel sleepy will help ensure you frequently get enough restorative sleep.
• If people can’t keep a consistent sleep schedule due to unavoidable commitments (e.g. shift work), then catch-up sleep is recommended.
• Watch for the symptoms of insufficient sleep such as daytime drowsiness, fatigue, struggling to maintain concentration, poor memory, and potentially making errors while driving. This may be due to not sleeping enough, or the sleep not being restorative enough due to poor sleep quality – as occurs with obstructive sleep apnoea, for example.
• People who feel like they might not be sleeping enough, especially those currently sleeping less than seven hours, could test whether allowing a longer sleep schedule or naps helps them sleep longer and results in them feeling more rested.
• For those without a sleep disorder, following good sleep hygiene may be beneficial. Avoiding caffeine and alcohol in the afternoon/reducing their caffeine and alcohol consumption across the day, and/or avoiding a heavy meal close to bedtime may help people fall asleep faster and sleep for longer. Others may not see much benefit from following sleep hygiene advice, but it is worth trying as it may be a relatively simple fix to their sleep problems.
• People should consult their GP in the first instance if they are concerned about their sleep. Treatment options are available through referrals to sleep specialists for a variety of sleep disorders such as sleep apnoea and insomnia.

The article, Are we getting enough sleep? Frequent irregular sleep found in an analysis of over 11 million nights of objective in-home sleep data (December 2023) 

26% lower risk of heart failure with each 3,600 steps per day

 The science is clear that movement is good for our bodies as we age. But just how much physical activity is beneficial for people over 60? A new study from the University at Buffalo provides an answer, and it’s not 10,000 steps per day.

In fact, the study — published Feb. 21 in JAMA Cardiology — of nearly 6,000 U.S. women aged 63-99 reports that, on average, 3,600 steps per day at a normal pace was associated with a 26% lower risk of developing heart failure.

The observational study from the Women’s Health Initiative specifically looked at accelerometer-measured physical activity, sedentary time and heart failure risk. There were 407 heart failure cases — confirmed by physicians — identified during a mean follow-up of 7.5 years.

The risk of developing heart failure was, on average, 12% and 16% lower for each 70 minutes per day spent in light intensity activities and each 30 minutes per day spent in moderate-to-vigorous intensity, respectively. To the contrary, each hour-and-a-half of sedentary time was associated, on average, with a 17% higher risk of experiencing heart failure.

“In ambulatory older women, higher amounts of usual daily light and moderate intensity activities were associated with lower risk of developing heart failure with preserved ejection fraction independent of demographic and clinical factors associated with heart failure risk,” says the study’s lead author Michael J. LaMonte, PhD, research professor of epidemiology and environmental health in UB’s School of Public Health and Health Professions. “Accumulating 3,000 steps per day might be a reasonable target that would be consistent with the amount of daily activity performed by women in this study.”

Study participants wore an accelerometer on their hip for up to seven consecutive days, except for when in water. Light physical activity included usual daily activities like self-care, chores around the house and caregiving, while moderate to vigorous activity involved walking at a normal pace, climbing the stairs or doing yard work.

The study is unique in that it looked at two subtypes of heart failure, the most common of which is heart failure with preserved ejection fraction, often abbreviated as HFpEF. A similar pattern of lower risk with more light and moderate intensity daily activity, and higher risk with prolonged sedentary time, was seen for HFpEF.

“This is a major, unique finding of our study because there is very little published data on physical activity and HFpEF, so we are providing new information upon which other studies can build,” LaMonte says.

“More importantly, HFpEF is the most common form of heart failure seen in older women and among racial and ethnic minority groups, and at present there are few established treatment options, which makes primary prevention all the more relevant for HFpEF. The potential for light intensity activities of daily life to contribute to the prevention of HFpEF in older women is an exciting and promising result for future studies to evaluate in other groups, including older men,” LaMonte adds.

The team’s evaluation of the number of steps per day as an approach to quantifying and translating the favorable results for physical activity was also novel, says LaMonte.

Encouraging older adults to be more active as part of healthy aging is sound advice well-supported by scientific evidence.

“However, conveying how much activity is always a challenge to incorporate as part of clinical and public health recommendations,” says LaMonte. “Steps per day is easily understood and can be measured by a variety of consumer-level wearable devices to help people monitor their physical activity levels.”

In this study, the risk of heart failure, including HFpEF, became significantly lower at around 2,500 steps per day. When standardized to 3,600 steps per day (1 standard deviation unit), there was a 25-30% lower risk of heart failure and HFpEF.

The study’s findings come at a time when the U.S. government is examining its physical activity guidelines for older adults, particularly a target number of steps per day. The steps per day associated with lower heart failure risk cited in the study are far fewer than the often recommended 10,000 steps for health and wellness.

For perspective, the average number of steps per day among women in the study was 3,588. The average among U.S. women of similar age is 2,340.

“It appeared that intensity of stepping did not influence the lower risk of heart failure as results were comparable for light intensity steps and for more vigorous steps,” says LaMonte.

“Our results showing heart failure prevention in older women might be enhanced through walking around 3,000 steps or so per day at usual pace is very relevant given the current emphasis at the federal level on identifying an amount of daily physical activity that can be referenced against steps per day for cardiovascular health and resilience to incorporate in future public health guidelines.”

 

With regular exercise, medical weight loss treatment does not have to be permanent

 

For nearly a year, we have been debating weight loss drugs like Wegovy, Zepbound, Saxenda and similar products and what happens when people stop taking them. Are they able to maintain weight loss? A new Danish study sheds light on the matter.

You have probably noticed that weight loss drugs like Wegovy have been the subject of debate for some time now. And for good reason. Because in a world where more and more people live with obesity, they help people lose excess fat.

Unfortunately, there is a downside. The general perception is that those who stop taking the medication will have difficulties maintaining weight loss. But that is not necessarily the case. So says Professor Signe Sørensen Torekov from the Department of Biomedical Sciences, who is leading a new study conducted at the University of Copenhagen and Hvidovre Hospital.

“It is actually possible to stop taking the medication without large weight regain, if you follow a structured exercise regime. Our study offers new hope, as we have shown that the majority of those who take weight loss medication and exercise regularly are able to maintain the beneficial effects a year after treatment termination,” she says.

In the new study, the team of researchers have studied the effects following treatment for obesity, and they have been able to answer some of the key questions about these relatively new types of drugs.

And the results speak for themselves. So says Postdoc Simon Birk Kjær Jensen, who is first author of the study, which formed part of his PhD thesis.

“Even though medical treatment for obesity is effective, people who stop taking the drugs have difficulties maintaining the beneficial effects. Within a year, they will typically have gained more than two thirds of the lost weight. However, our study shows that people who exercise during treatment do not have the same propensity to put on weight post treatment,” he says.

Two hours of exercise a week is enough

The study included four groups of test participants. One group was given a placebo, another group was given a weight loss drug, Saxenda, liraglutide 3 mg to be exact, a third group was asked to exercise, while a fourth group was given the weight loss drug and exercised regularly. Before being divided randomly into groups, all the participants had eaten a diet low on calories.

The results of the study show that those who exercised during treatment did not have to spend more than a couple of hours a week in training shoes to maintain the beneficial effects of the treatment.

“All it takes is two hours of exercise a week that gets the heart rate up and makes you pant. And it may differ from one person to the next. For people with severe obesity and low initial fitness level, a brisk walk may be sufficient, whereas people with higher fitness level may have to practise running or cycling, e.g. interval spinning,” Simon Birk Kjær Jensen explains. 

In fact, the study shows that the exercise groups experienced better quality of life.

“From our data, it is clear that those who followed an exercise regime with or without treatment with obesity drugs felt less tired and more energetic. They also experienced better mental health. It simply led to improved quality of life,” Signe Sørensen Torekov says and adds:

“The same did not apply to those who only received medical treatment. In fact, they felt more tired and less energetic.”

Prescription exercise

According to the researchers responsible for the new study, there is therefore reason to consider adding exercise recommendations to prescriptions for weight loss drugs to increase people’s chances of maintaining weight loss and the beneficial effects post treatment.

“We now have an effective drug for obesity, and we need it, because a lot of people are suffering from obesity. But according to our data, it is super important to combine medical treatment with regular physical exercise, because of the beneficial effects hereof, e.g. better quality of life and muscle mass maintenance,” Simon Birk Kjær Jensen says, to which Signe Sørensen Torekov adds:

“The study almost makes me want to advise against medical treatment without increased physical exercise, especially if you do not want to be taking the drugs for the rest of your life. We need to stop thinking that people who weigh less also exercise more, because that is simply not the case. It requires structure, support and habit building,” Signe Sørensen Torekov says and adds: 

“The good news is that post-treatment weight loss maintenance is possible, but only when combined with exercise.”

The study, ’Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomized placebo-controlled trial’, just published in LANCET eClinicalMedicine.

Mediterranean diet improves kidney health in patients with diabetes

 

 

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IMAGE OF THE TEAM THAT CARRIED OUT THE RESEARCH.

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CREDIT: UNIVERSITY OF CÓRDOBA

The Mediterranean diet garners praise once again, with another study ratifying its list of health benefits. In addition to preventing cardiovascular accidents, boosting the immune system, and averting oxidative stress, this diet can also help slow the deterioration of the kidneys. It is a benefit that, although already known by the scientific community, now, for the first time, has been demonstrated in patients suffering from Type-2 diabetes, a condition affecting almost 15% of the Spanish population, according to the latest report by the Spanish Diabetes Society.

This is at least one of the main conclusions of a new study published by the University of Cordoba (UCO) and the Maimonides Institute for Biomedical Research (IMIBIC). The work has managed to unravel one of the reasons for this relationship between the Mediterranean diet and the improvement of kidney function; that is, one of the molecular mechanisms by which this phenomenon occurs.

 
The key lies in compounds called Advanced Glycation End Products, better known as AGEs. As one of the researchers participating in the study, Alicia Podadera, points out, these are molecules with an inflammatory and oxidizing capacity. They can be produced naturally in the human body, and also ingested, depending on one's diet. Although they are usually discharged through urine, diabetic patients with kidney problems (one of the most recurrent complications) have more trouble eliminating them, such that the levels of these products in their bodies are usually higher. 

The study, carried out by the Nutrigenomics and Metabolic Syndrome Group at the IMIBIC, analyzed the levels of these harmful compounds in more than 500 diabetics, comparing, over a period of 5 years, how two types of healthy diets affect the body: the Mediterranean diet and another low-fat diet richer in carbohydrates.

According to the results of the study, patients who had eaten a Mediterranean diet during those years had lower levels of these harmful compounds in their blood. "We were able to verify that this diet better activates the detoxification process; that is, the mechanism by which the body eliminates these harmful substances," said Francisco Miguel Gutiérrez, another of the study's authors.

Although the relationship between these compounds and kidney disease was already known, this is the first demonstration of "how a defined dietary pattern can mitigate the deterioration of kidney function in diabetic patients," says researcher Elena Yubero. The Mediterranean diet, therefore, "could be an effective strategy for the management of these substances," she concludes.

There are multiple reasons why this diet is beneficial for health. In addition to the antioxidant capacity of Extra Virgin Olive Oil (EVOO), previous studies have shown how ways of cooking with it also play an important role. For example, foods that are cooked at high temperatures for short periods of time "contain a higher amount of these harmful substances" than other cooking techniques typical of the Mediterranean diet that "require longer cooking times, and are gentler on the food," Yubero said. 

This work was published within the framework of the Cordioprev study, carried out over the course of seven years with more than 1,000 patients with heart disease, and in which the differences between a healthy low-fat diet and a Mediterranean diet rich in virgin olive oil are compared. This clinical trial, overseen by Professor José López Miranda and carried out by the IMIBIC, UCO and Spain's Biomedical Research Centre in the Physiopathology of Obesity and Nutrition  (CIBEROBN), received the National Gastronomy Award for Research and Innovation last year.
 

Exercise regularly or one-to-two days a week, weight loss is possible

Whether you engage in physical activity on a regular basis or one-to-two days a week, both options produce weight loss suggests a new study published in the journal Obesity, The Obesity Society’s (TOS) flagship journal. The study is the first of its kind to examine the association between physical activity patterns and objectively-measured fat tissue mass.

Guidelines from the World Health Organization recommend that adults perform at least 150 minutes per week of moderate physical activity, 75 minutes per week of vigorous physical activity or an equivalent combination of both intensities. However, many individuals find it challenging to meet this recommendation due to physical activity being time consuming in a fast-paced society. The new study found that people defined by researchers as “weekend warriors”—individuals who condense their exercise into one-to-two days a week—can also lose weight similar to individuals who exercise on a regular basis as long as they achieved the recommended goals.

“The weekend warrior pattern is worth promoting in individuals who cannot meet the recommended frequency in current guidelines,” said Lihua Zhang, health care scientist, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Zhang is one of the corresponding authors of the study.

Zhang suggested that office workers, bus drivers and other employees who have to sit for many hours during the work day care about the research. “Those people are struggling to catch up in their exercise plan in daily life to offset the hazard of a sedentary lifestyle but have less free time to get to the gym,” she said. “Our study could offer them an alternative choice to keep fit,” said Zhang, who added that there are suitable activities for weekend warriors such as climbing, hiking, cycling or running.

Researchers extracted data from more than 9,600 participants in the National Health and Nutrition Examination Survey from 2011 to 2018. Participants ranged in age from 20- to 59-years-old.

Abdominal and general adiposity were assessed by dual-energy x-ray absorptiometry (DXA)—a non-invasive and easily accessible body composition scan—and anthropometric measures. Physical activity levels were collected from the Global Physical Activity Questionnaire and classified as inactive, weekend warrior and regularly active. Survey linear regression models were used to assess associations between physical activity patterns and adiposity indicators.

Results showed that 772 participants reported the weekend warrior pattern and 3,277 reported the regularly active pattern. Compared to the 5,580 inactive participants, both the weekend warrior and regular active groups had lower DXA-measured abdominal adiposity, waist circumference, whole-body fat mass and body mass index. These two groups were also younger, more likely to be non-Hispanic White, have higher educational backgrounds, and less likely to be unemployed or to have hypertension or diabetes.

"On a high level, this study reaffirms the old adage about physical activity and health: any activity is better than no activity. Notably, the weekend warriors' workout was of higher intensity and longer duration, and more intensity and longer duration correlated with even lower abdominal fat. The main takeaway, though, is that people should be active in any manner that suits their lifestyle,” said Assistant Professor of Clinical Medicine Beverly Tchang, MD, DABOM, Comprehensive Weight Control Center, Weill Cornell Medicine in New York. Tchang was not associated with the research study.

Steven B. Heymsfield, MD, professor, Pennington Biomedical Research Center, Baton Rouge, La., who was also not associated with the study added, “Findings in a cross-sectional sample such as reported by the study’s researchers need confirmation in prospective longitudinal studies.”

Fasting-like diet lowers risk factors for disease, reduces biological age in humans

Cycles of a diet that mimics fasting can reduce signs of immune system aging, as well as insulin resistance and liver fat in humans, resulting in a lower biological age, according to a new USC Leonard Davis School of Gerontology-led study.

The study, which appears in Nature Communications on Feb. 20, adds to the body of evidence supporting the beneficial effects of the fasting-mimicking diet (FMD).

The FMD is a five-day diet high in unsaturated fats and low in overall calories, protein, and carbohydrates and is designed to mimic the effects of a water-only fast while still providing necessary nutrients and making it much easier for people to complete the fast. The diet was developed by the laboratory of USC Leonard Davis School Professor Valter Longo, the senior author of the new study.

“This is the first study to show that a food-based intervention that does not require chronic dietary or other lifestyle changes can make people biologically younger, based on both changes in risk factors for aging and disease and on a validated method developed by the Levine group to assess biological age,” Longo said.

Previous research led by Longo has indicated that brief, periodic FMD cycles are associated with a range of beneficial effects. They can:

• Promote stem cell regeneration
• Lessen chemotherapy side effects
• Reduce the signs of dementia in mice

In addition, the FMD cycles can lower the risk factors for cancer, diabetes, heart disease and other age-related diseases in humans.

The Longo lab also had previously shown that one or two cycles of the FMD for five days a month increased the healthspan and lifespan of mice on either a normal or Western diet, but the effects of the FMD on aging and biological age, liver fat, and immune system aging in humans were unknown until now.

Lower disease risks & more youthful cells

The study analyzed the diet’s effects in two clinical trial populations, each with men and women between the ages of 18 and 70. Patients who were randomized to the fasting-mimicking diet underwent 3-4 monthly cycles, adhering to the FMD for 5 days, then ate a normal diet for 25 days.

The FMD is comprised of plant-based soups, energy bars, energy drinks, chip snacks, and tea portioned out for 5 days as well as a supplement providing high levels of minerals, vitamins, and essential fatty acids. Patients in the control groups were instructed to eat either a normal or Mediterranean-style diet.

An analysis of blood samples from trial participants showed that patients in the FMD group had lower diabetes risk factors, including less insulin resistance and lower HbA1c results. Magnetic resonance imaging also revealed a decrease in abdominal fat as well as fat within the liver, improvements associated with a reduced risk of metabolic syndrome. In addition, the FMD cycles appeared to increase the lymphoid-to-myeloid ratio – an indicator of a more youthful immune system.

Further statistical analysis of the results from both clinical studies showed that FMD participants had reduced their biological age – a measure of how well one’s cells and tissues are functioning, as opposed to chronological age – by 2.5 years on average.

“This study shows for the first time evidence for biological age reduction from two different clinical trials, accompanied by evidence of rejuvenation of metabolic and immune function,” Longo said.

The study, conducted by first authors Sebastian Brandhorst, USC Leonard Davis research associate professor, and Morgan E. Levine, founding principal investigator of Altos Labs and USC Leonard Davis PhD alumna, lends more support to the FMD’s potential as a short-term periodic, achievable dietary intervention that can help people lessen their disease risk and improve their health without extensive lifestyle changes, Longo said.

“Although many doctors are already recommending the FMD in the United States and Europe, these findings should encourage many more healthcare professionals to recommend FMD cycles to patients with higher than desired levels of disease risk factors as well as to the general population that may be interested in increased function and younger age,” Longo said.

Could ultra-processed foods be the new ‘silent’ killer? Peer-Reviewed Publication

 

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ULTRA-PROCESSED FOODS ARE PACKED WITH ADDITIVES AND EMULSIFIERS THAT STRIP FOOD OF HEALTHY INGREDIENTS THAT COULD BE DETRIMENTAL TO HUMAN HEALTH. 

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CREDIT: ALEX DOLCE, FLORIDA ATLANTIC UNIVERSITY

From fizzy drinks to cereals and packaged snacks to processed meat, ultra-processed foods are packed with additives. Oil, fat, sugar, starch and sodium, as well as emulsifiers such as carrageenan, mono- and diglycerides, carboxymethylcellulose, polysorbate and soy lecithin continue to strip food of healthy nutrients while introducing other ingredients that could also be detrimental to human health.

Hundreds of novel ingredients never encountered by human physiology are now found in nearly 60 percent of the average adult’s diet and nearly 70 percent of children’s diets in the United States.

While obesity and lack of physical activity are well recognized contributors to avoidable morbidity and mortality in the U.S., another emerging hazard is the unprecedented consumption of these ultra-processed foods in the standard American diet. This may be the new “silent” killer, as was unrecognized high blood pressure in previous decades.

Physicians from Florida Atlantic University’s Schmidt College of Medicine explored this hypothesis and provide important insights to health care providers in a battle where the entertainment industry, the food industry and public policy do not align with their patients’ needs. Their findings are published in a commentary in The American Journal of Medicine.

“Those of us practicing medicine in the U.S. today find ourselves in an ignominious and unique  position – we are the first cohort of health care professionals to have presided over a decline in life expectancy in 100 years,” said Dawn H. Sherling, M.D., corresponding author, associate program director for the internal medicine residency and an associate professor of medicine, FAU Schmidt College of Medicine. “Our life expectancy is lower than other economically comparable countries. When we look at increasing rates of non-communicable diseases in less developed nations, we can see a tracking of this increase along with increasing consumption of ultra-processed foods in their diets.”

Although professional organizations such as the American College of Cardiology cautions patients to “choose minimally processed foods instead of ultra-processed foods” in their 2021 dietary guidelines, there is a caveat that “there is no commonly accepted definition for ultra-processed foods, and some healthy foods may exist within the ultra-processed food category.”

“When the components of a food are contained within a natural, whole food matrix, they are digested more slowly and more inefficiently, resulting in less calorie extraction, lower glycemic loads in general, and lower rise in triglyceride-rich lipoproteins after eating, which could result in atherosclerotic plaque,” said Allison H. Ferris, M.D., senior author, an associate professor and chair, Department of Medicine, and director of the internal medicine residency program, FAU Schmidt College of Medicine. “Therefore, even if the troublesome additives were removed from the ultra-processed food, there would still be concern for an over-consumption of these products possibly leading to obesity, diabetes and heart disease.”

The authors add that public health organizations are increasingly making use of the NOVA classification system, which divides foods into four categories – whole foods, culinary ingredients (items like butter, oil and salt), traditionally processed foods (such as bread and yogurt made with few ingredients), and ultra-processed foods – or those foods that are industrially made and use ingredients not normally found in a domestic kitchen.

According to the authors, one plausible mechanism to explain the hazards is that ultra-processed foods contain emulsifiers and other additives that the mammalian gastrointestinal tract mostly does not digest. They may act as a food source for our microbiota, and as such may be creating a dysbiotic microbiome that can, in the right host, promote disease.           

“Additives, such as maltodextrin, may promote a mucous layer that is friendly to certain species of bacteria that are found in greater abundance in patients with inflammatory bowel disease,” said Sherling. “When the mucous layer is not properly maintained, the epithelial cell layer may become vulnerable to injury, as has been shown in feeding studies using carrageenan in humans and other studies in mice models, using polysorbate-80 and cellulose gum, triggering immunologic responses in the host.”

The authors add that there have been marked increases in colorectal cancer in the U.S., especially among younger adults. They opine that increased ultra-processed food consumption may be a contributor as well as to several other gastrointestinal diseases.

 “Whether ultra-processed foods contribute to our currently rising rates of non-communicable disease requires direct testing in analytic studies designed a priori to do so,” said Charles H. Hennekens, M.D., FACPM, co-author, the First Sir Richard Doll Professor of Medicine and senior academic advisor, FAU Schmidt College of Medicine. “In the meantime, we believe it is incumbent upon all health care professionals to discuss the benefits of increasing consumption of whole foods and reducing consumption of ultra-processed foods with their patients.”  

 The authors also opine that just as the dangers of tobacco began to emerge during the middle of the prior century, decades passed before the preponderance of the evidence and the efforts of forward-thinking health officials prompted policy change to discourage the use of cigarettes. They say there is likely to be a similar path for ultra-processed foods.

“The multinational companies that produce ultra-processed foods are just as, if not more, powerful than tobacco companies were in the last century, and it is unlikely that governments will be able to move quickly on policies that will promote whole foods and discourage the consumption of ultra-processed foods,” said Sherling. “Importantly, health care providers also should remain cognizant of the difficulties that many of our patients have in being able to afford and find healthier options, which calls for a broader public health response.”