Another Reason to Eat Well: a Healthy Diet

Researchers have found another reason to eat well: a healthy diet helps prevent kidney stones. Loading up on fruits, vegetables, nuts, low-fat dairy products, and whole grains, while limiting salt, red and processed meats, and sweetened beverages is an effective way to ward off kidney stones, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). Because kidney stones are linked to higher rates of hypertension, diabetes, increased body weight, and other risk factors for heart disease, the findings have considerable health implications.

Eric Taylor, MD (Maine Medical Center) and his colleagues at Brigham and Women’s Hospital conducted a large study to determine the effects of healthy eating habits on the formation of kidney stones. The investigators collected information from individuals enrolled in three clinical studies: the Health Professionals Follow-up Study (45,821 men followed for 18 years), the Nurses’ Health Study I (94,108 older women followed for 18 years), and the Nurses’ Health Study II (101,837 younger women followed for 14 years).

Dr. Taylor’s team assigned a score to each participant based on eight components of a DASH (Dietary Approaches to Stop Hypertension) style diet: high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains and low intake of salt, sweetened beverages, and red and processed meats. Individuals with higher DASH scores consumed diets that were higher in calcium, potassium, magnesium, oxalate, and vitamin C and lower in sodium.

A total of 5,645 incident kidney stones developed in the participants in the three studies. In each study, participants with the highest DASH scores were between 40% and 45% less likely to develop kidney stones than participants with the lowest DASH scores. The reductions in kidney stone risk were independent of age, body size, fluid intake, and other factors.

Because a DASH-style diet may affect the development of hypertension, diabetes, and other chronic diseases associated with kidney stones, the researchers also performed an analysis limited to study participants without hypertension or diabetes. Even among those individuals the DASH diet reduced the risk of kidney stones.

Many of the medications used to treat kidney stones have unpleasant side effects. This study indicates that adopting a DASH-style diet may be an effective alternative.

The authors report no financial disclosures. Study co-authors include Teresa Fung (Simmons College) and Gary Curhan, MD (Brigham and Women’s Hospital).

The article, entitled “DASH-Style Diet Associates with Reduced Risk for Kidney Stones,” will appear online at http://jasn.asnjournals.org/ on August 13, 2009, doi 10.1681/ASN.2009030276.

The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, the American Society of Nephrology (ASN) is the world’s largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Simple Steps for a Healthier You

Quit Smoking. Lose weight. Get more exercise. These are popular New Year’s resolutions, but they are undoubtedly a chore. A third of resolutions, however well motivated, are broken within a week.

If better health is your aim, there are many other simple, less obvious things you can do – without a great deal of effort. Here are a few recommended by physicians at Rush University Medical Center.

Have fun to help de-stress. Experts recommend regular exercise, meditation and breathing techniques to reduce stress, but even something as simple as listening to soothing music, reading a good book, soaking in a hot tub or playing with your pet can help you relax. “Spending just 30 minutes a day doing something you enjoy can go a long way toward beating the stressors of everyday life,” says cardiologist Dr. Annabelle Volgman, director of the Rush Heart Center for Women. That’s advice you should take to heart because prolonged stress can cause or exacerbate a number of health problems — some serious — including heart disease, stroke, hypertension, depression, ulcers, irritable bowel syndrome, migraines and obesity.

Practice good oral hygiene. Spend a minimum of two minutes to brush your teeth twice a day — and don’t forget the dental floss. Daily flossing and brushing of teeth not only help prevent cavities but may keep other diseases at bay as well. Experts suspect that bacteria-producing dental plaque, which leads to gum inflammation, can result in or exacerbate heart disease. Although the exact mechanism of why this occurs is not clear, a connection has also been found between poor periodontal health and stroke, diabetes, premature births and low birth weights. “It’s also a good idea to take a three-hour break between eating foods that contain sugar,” says Dr. Joel Augustin, a family medicine physician at Rush.

Do a crossword puzzle. Researchers at Rush have found that mentally challenging activities, such as reading and playing chess, may have a protective effect on your brain. “Regularly engaging your mind may help lower your risk for the dementia associated with Alzheimer’s disease,” Dr. Augustin says.

A little red wine is fine. Recent studies have shown that the powerful antioxidants found in red wine protect against heart disease, colon cancer, anxiety and depression. So unless there is a medical reason why you shouldn’t imbibe, go ahead and enjoy that glass of merlot with your nightly meal — you can even toast to your good health.

But don’t drink excessively. Just as a small amount of red wine has health benefits, too much alcohol — even red wine — can cause a variety of health problems, including liver and kidney disease and cancer. Women, in particular, need to be careful about alcohol consumption. “Women are at higher overall risk of liver problems than men, so they are more likely to experience liver problems from smaller amounts of alcohol,” says Dr. Carline Quander, a gastroenterologist at Rush. “They simply shouldn’t drink as much as men.” For a healthy man, two drinks a day is not likely to do harm; women, on the other hand, should limit themselves to one daily drink.

Stop the snore cycle. When half of a couple snores, the other person loses sleep. The snorer is frequently tired too because people who snore loudly often have sleep apnea. In the most common form of this condition, the airway is blocked, causing the person to stop breathing and wake up repeatedly. Physicians at the Sleep Disorders Service and Research Center at Rush found that treating the snorer with continuous positive airway pressure, which keeps the airway open, results in better sleep for both people.

Don’t skip the seatbelt — ever. Even if you’re driving only a short distance or are in a parking lot, take a few seconds to fasten your safety belt, which prevents you from being tossed around the car or thrown from it in the event of a crash. Most cars these days are equipped with air bags, but these lifesaving features are designed to work with safety belts. According to National Highway Traffic Safety Administration, air bags alone are only 42 percent effective in providing protection.

Check your ergonomics. If you work at a computer, look at the ergonomics of your workstation — how you fit and move in your environment. You can start by visiting the Division of Occupational Health and Safety at http://dohs.ors.od.nih.gov. “An ergonomics review can help you avoid neck, back and eye strain,” Dr. Augustin says.

Even small steps toward better health can yield surprising rewards.

Seven Habits (To Break) Of Highly Effective People

During tough financial times, many people try to demonstrate their value at work by working harder and longer. But, if you don’t also make time to take care of yourself, success may come at a hefty cost: your health.

“Many people feel like they have to push themselves to unhealthy levels in order to succeed. But high-pressure jobs and long hours take a real toll on your immediate and future health,” says George Griffing, M.D., professor of internal medicine at Saint Louis University.

Whether you’re running for president, moving up the corporate ladder or juggling your family’s activities, it’s crucial that you take a break to care for yourself, he says.

These are the seven worst habits of workaholics, according to Griffing.

1. Forgetting to relax: While some stress can be good because it keeps you alert and motivated, too much stress or chronic stress will take its toll on your body. In fact, stress can cause a wide-array of problems including: cancer, heart disease, headaches, upset stomach, sleeping problems, muscle tension, weight gain/loss, high blood pressure and chest pains.

2. Eating on the go: Between meetings, conference calls and deadlines, who has time to sit down for a healthy lunch? But a healthy, balanced meal of complex carbohydrates, protein, fruits and vegetables is exactly what you need to stay mentally sharp throughout the day. Beware of frozen meals, fast food and processed food; they can be high in sodium, calories and fat.

3. Putting off sleep for work: Even busy professionals need seven to nine hours of sleep every night. Skimping on sleep can cause irritability, difficulty concentrating, memory problems and poor judgment. It has also been linked to obesity. If you have troubles sleeping at night, avoid bringing work to bed, limit caffeine and alcohol consumption and develop a relaxing routine before bedtime, such as light reading or a warm bath. If you still cannot sleep, seek the help of an expert.

4. Not making time for exercise: Humans were not designed to sit at desks for eight hours or more a day. Getting at least 30 minutes of exercise most days is very important to your immediate and future health. In addition to reducing the risk for nearly every major disease, exercise has been shown to help fight anxiety and depression. By hitting the gym before or after work or walking during lunch, even the busiest person can find time to squeeze in exercise.

5. Working even when sick: Everyone has heard, “don’t come to work if you’re sick,” yet that’s exactly what many do. Whether you’re worried about jeopardizing your job in an unstable economy or just anxious about getting behind, there are three common sense reasons to stay home: Nobody wants your germs, you’ll be less productive and you need your rest to get better.

6. Drinking (too much): The saying “too much of a good thing” certainly applies to alcohol. Research has shown that moderate alcohol consumption can reduce your risk for everything from heart disease to rheumatoid arthritis, with “moderate” being the key word. In general, men should have no more than two drinks per day (1.5 oz. of spirits, 5 oz. of wine or 12 oz. of beer) and women who are not pregnant should limit themselves to one drink per day. Remember, the risks of excessive drinking far outweigh the benefits of alcohol consumption and can lead to alcoholism, liver disease and some forms of cancer.

Instead of drinking several cocktails to cope with stress or unwind after a busy day, try sipping herbal tea, meditation or yoga.

7. Skipping annual medical checkups: In order to detect problems early, prevent others from developing and get the best treatment if you have a condition, you need to know what’s going on in your body. Depending on your age, family history and lifestyle, consider a comprehensive medical checkup and special screenings every one to five years. Consult with your doctor for more information.

“Eventually, something’s going to give. If you keep burning the candle at both ends, the flame will burn out,” Griffing said. “But if you maintain a healthy balance, you will be happier and healthier overall.”

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.

Laparoscopic Banding Procedure Helps Overweight Adolescents Lose Weight and Improve Health

NEW ORLEANS, Oct. 9 (medianowonline)- As the number of
overweight children in the United States approaches epidemic proportions,
one group of surgeons is taking an active role in researching new ways to
reduce obesity rates in children. Evan Nadler, MD, and colleagues at the
New York University School of Medicine have been researching the
effectiveness of surgical intervention to help morbidly obese children lose
weight: they studied the effect of laparoscopic banding procedures on
weight loss in a group of 14- to 17-year-olds who were extremely
overweight. They reported their findings at the 2007 Clinical Congress of
the American College of Surgeons.

To be eligible for the study, teenage patients had to meet National
Institutes of Health (NIH) guidelines for weight loss surgery, having
either a BMI (body mass index) of 35 with at least one cormorbidity
(weight-related illness) or a BMI of 40 without. According to Dr. Nadler,
"Generally, participants had to be about 100 pounds or more overweight."
Participants also had to have been obese for five or more years and had to
have failed medically supervised attempts at weight loss for six months or
more, Dr. Nadler explained.

Being overweight places people at risk for other illnesses (or
comorbidities), including type 2 diabetes (high blood sugar), hypertension
(high blood pressure), heart disease, stroke, sleep apnea, gallbladder
disease, liver disease, some types of cancer, and irregular menstrual
periods. Dr. Nadler also notes, "These individuals typically have back pain
or joint pain. They can have depression -- actually, the mental health side
of this is vastly underappreciated in my opinion. Obesity is devastating to
these children's social development."

Currently, two major operations for weight loss in adults are performed
in the United States: the gastric bypass procedure and the laparoscopic
adjustable gastric band procedure. Dr. Nadler's group studied the use of
the laparoscopic adjustable gastric band on adolescents. He was
particularly interested in studying this procedure because "Gastric bypass
has a mortality rate of about one percent in the adult population; the lap
band mortality rate is about 20 times less. Therefore, in my estimation,
it's a better operation for teenagers because it's safer," Dr. Nadler
explains. "Gastric bypass probably is a little bit more effective in terms
of absolute weight loss than gastric banding, but the amount of weight you
need to lose to have your obesity-related illnesses get better is about 20
percent of your excess weight." With the gastric band, the weight loss was
found to be "about 50 percent of your excess weight while the bypass may be
closer to 60 percent." As for the difference in the rates of weight loss,
Dr. Nadler notes "As long as the obesity-related illnesses get better, I
don't really care if you're a size 8 as opposed to a size 10. Getting the
extra pounds of weight loss is not worth a 20-fold increase in the
likelihood of dying," he explained.

The gastric banding procedure itself is minimally invasive and is
performed laparoscopically. This procedure involves putting a camera
through a small abdominal incision and using special, long instruments that
allow the surgeons to do the procedure without making a real cut in the
abdomen. Dr. Nadler describes the procedure this way: "Surgeons make five
small holes in the abdomen and place the band around the top of the
stomach. The band itself has a balloon on the inside of it which is
connected to a port. We access the port periodically to inflate the balloon
to tighten it, and as the band gets tighter, the patient experiences a
sense of fullness and then they're not hungry any more, and thus they don't
eat very much." As a conservative measure, the children were kept in the
hospital overnight; in adults, however, the operation can be done on an
outpatient basis and takes about an hour to an hour and a half to complete.

Dr. Nadler and colleagues used a scanning technique called DEXA
(dual-energy x-ray absorptiometry) to assess body composition. "The reason
body composition is important, is that there are a multitude of studies
that show that fat loss centrally is much more important than fat loss
peripherally. So men who carry their fat in the bellies are at higher risk
for bad comorbidities than some women who carry their fat on their hips and
thighs." These are commonly called the "apple" and "pear" shapes,
respectively. While previously published studies had shown that
laparoscopic adjustable banding was effective in producing weight loss, "We
wanted to know whether the weight loss was central or peripheral (ie.,
apple or pear) and then whether we were able to reverse the comorbidities
in our patients significantly," Dr. Nadler said.

In the study presented at the ACS Clinical Congress, the researchers
reported on a one-year follow-up data on 14 of the adolescent participants.
They found fat mass, lean mass, and android (male-pattern visceral) fat
were all significantly decreased. Prior to the operation, there were a
total of 43 comorbidities in all 14 participants, back pain, dyslipidemia
(a lipoprotein metabolism disorder) depression, osteoarthritis, and sleep
disorders. At one-year follow-up, 34 of these factors were reassessed and
the vast majority had improved. Twenty-five comorbidities were completely
resolved and five were improved, for a total improvement rate of 70 percent
in obesity-related illnesses, Dr. Nadler reported.

In terms of how this surgical procedure impacts lifestyle, Dr. Nadler
says, "We think of it as a behavior modification tool. It really changes
the way you eat. It forces you to. There's no choice." While some patients
may have to endure a second operation if the band slips out of position,
this is relatively uncommon, occurring in less than 10 percent of cases.
More importantly, Dr. Nadler says, "This particular study shows that the
weight loss associated with laparoscopic adjustable gastric banding in
adolescents is the important weight loss: it's the weight loss of central
fat which directly relates to the comorbid conditions associated with
obesity. So this particular dataset shows that you lose central fat, and
that for a large majority of our patients, their comorbidities are resolved
and/or improved."

According to Dr. Nadler, "Childhood obesity is a very controversial
topic and probably the most pressing health care issue facing children
today. What to do about it is certainly discussed among many experts, and I
think everyone agrees that prevention is the ideal strategy. But then the
question is, what do you do with all these children who are already 100
pounds overweight and are now getting sick from being that overweight?"

"It has been estimated that there are a million children in the US who
would qualify for obesity surgery based on their current weight and medical
illnesses related to their weight. We have been looking at children ages 14
to 17 for now, because that's the age group just younger than adults.
Whether or not the evaluation will expand to younger patients in the future
is unclear. But certainly there even are 12-year-olds these days who are so
overweight that they have severe medical problems based on their weight. I
think most of us would agree that if someone is really debilitated by their
weight, if they're 12 or 13, they might be a candidate for a lap-band
procedure, despite the fact they may not have reached their full adult
height," he observed. Dr. Nadler's study of the effect of gastric banding
on overweight adolescents is ongoing. Future studies will examine larger
numbers of adolescents.

In addition to Dr. Nadler, the research team included Valerie Peck, MD;
Christine Ren, MD, FACS; George Fielding, MD; and Shivani Reddy, MD.

SOURCE American College of Surgeons