Fatty Liver Disease: Another Reason to Avoid Obesity

An article in the January 2011 issue of the Harvard Health Letter reveals that the epidemic of obesity has increased the occurrence of fatty liver disease. Previously, most cases of fatty liver disease were related to excess alcohol consumption, but now, many cases are related to excess body fat, which can lead to Type II diabetes. Fatty liver disease affects 70-90% of those who are obese and/or have diabetes.

Abdominal obesity can lead to metabolic syndrome (elevated blood pressure and levels of triglycerides and blood sugar, and low HDL (good cholesterol). Overfilled fat cells become resistant to insulin (which lowers blood sugar by storing it in the cells) resulting in excess fatty acids in the blood. Fat then accumulates in liver cells, which can lead to inflammation and liver tissue damage.  This can in turn bring about liver fibrosis (buildup of fibrous tissue) or cirrhosis (buildup of scar tissue). Cirrhosis increases the risk of liver cancer.

Fatty liver disease increases the risk of heart attack and stroke because a fatty liver produces inflammatory factors that can promote the deposition of plaque in the arteries, leading to arterial narrowing.

The only effective treatment for fatty liver disease is to lose weight.

Bottom Line
If you want to avoid or reverse fatty liver disease, avoid gaining unnecessary body fat or lose existing excess body fat through a program of good nutrition and exercise. Both caloric restriction and exercise are essential parts of any weight-loss program.

As We Age, Cholesterol Level Loses Its Value as a Risk Factor

Because both a high total cholesterol level and a high LDL-cholesterol level are risk factors for heart disease, statin drugs, which lower both levels, are widely prescribed. In the U.S., more prescriptions are written for Lipitor, the most popular statin, than for any other drug. Estimates for the number of people who take statins range between 11 million and 30 million. But should so many people be taking statins? A recent analysis, in which scientists reviewed 14 studies that included data from over 34,000 patients, showed little evidence that statins prevent heart trouble in patients with no history of cardiovascular disease. And because there is some evidence linking low cholesterol levels with increased risk of death from other causes, the study authors feel that doctors should be more cautious about prescribing statins.

An important factor to consider when deciding whether or not to prescribe statins is the patient’s age. A study by Kronmal et al., entitled, “Total Serum Cholesterol levels and mortality risk as a function of age” in the Archives of Internal Medicine (vol. 153, pp. 1065-1073, 1993) examined how age affected the ability of cholesterol level to predict the risk of dying, and it showed that the predictive value declined with age.
The most important consideration when judging mortality risk is the overall likelihood of dying from any cause. In that regard, at age 40, those people with higher total serum cholesterol levels had a significantly higher all-cause mortality risk. However, the relationship declined with age, and by age 60, the relationship between total cholesterol level and all-cause mortality had vanished. By age 80, the relationship actually reversed, so that those with higher cholesterol levels were at significantly lower risk of dying.

Looking specifically at the risk of death from coronary heart disease, the death risk at ages 40, 50, and 60 years was greater for those with higher cholesterol levels, although the effect got smaller with age. By age 70, the relationship was still positive but weak, but by age 80 the relationship reversed, and those with higher cholesterol levels actually had less chance of dying.

Looking at death due to causes other than heart disease, (e.g. cancer), from age 50 on, there was a lower risk of dying as cholesterol levels rose. This apparent protective effect of cholesterol against non-heart-disease death increased with age. Seventy-three percent of 80 year-old men with cholesterol levels above 240 survived for 5 years, while only 49% of those with levels below 240 did. The effect was in the same direction but weaker for women, with a 74% and 70% 5-year survival rates for women with cholesterol levels respectively above and below 240 mg/dl. In regard to cancer alone, higher cholesterol level was associated with lower death risk.

Bottom Line
The current practice of the medical establishment of prescribing statins to anyone with a total cholesterol level above 200 appears to be unjustified. For patients with elevated cholesterol levels and a history of heart disease, statins provide a proven reduction in risk. However, for patients with mildly elevated levels and no history or heart disease, the evidence in favor of prescribing statins is weak or nonexistent. And for men above age 70, even those with cholesterol levels above 240, statins could very well increase the risk of death.

You May Not Be Getting Enough of These Nutrients

An article in the September 2010 issue of the Nutrition Action Health Letter contains a cover story entitled, “Getting Enough? What you don‘t eat can hurt you.” The article states that many of us are not getting enough potassium, magnesium, Vitamin D, or Vitamin B-12, with possible negative health consequences.

Potassium

• A third of Americans have high blood pressure, which increases the risk of heart attack and stroke. Over age 65, two-thirds of us have high blood pressure. More than half of those afflicted don’t have it under control.
• Potassium can help regulate blood pressure. Major studies have shown that people with higher potassium intake have lower blood pressure.
• A low potassium level is a predictor of stroke. A study of 43,000 subjects showed that those consuming the most potassium had 38 percent fewer strokes that those who consumed the least. The beneficial effect of potassium is the greatest for those who consume the most sodium. It is thought to work by increasing the flexibility of arteries and widening the tiny blood vessels.
• While blood pressure typically rises as one gets older, 4 weeks on a low sodium, high potassium diet can totally reverse the effect of age on blood pressure. The DASH Diet (Dietary Approaches to Stop Hypertension), which minimizes added salt and includes 11 daily servings of fruit and vegetables as well as 2 servings of low-fat dairy products and low quantities of saturated fats, refined sugar, and refined grains, provides plentiful potassium while keep sodium down to recommended levels.
• Potassium citrate is the form of potassium found in fruits and vegetables and it is considered more effective for blood-pressure reduction and safer than potassium supplements (usually potassium chloride), which can cause heart problems if taken in excess. Potassium citrate also reduces the risk of kidney stones by 50% and may help prevent bone loss.

 Vitamin D

• This nutrient seems more important than calcium for protecting bones and preventing osteoporosis, a  bone-thinning disease that causes bone fractures in 25% of men and 50% of women over age 50.
• Among Navy recruits, supplementation of 2,000 mg of calcium along with 800 IU of vitamin D per day reduced stress fractures by 20%.
• Evidence suggests that Vitamin-D also protects against colon cancer, heart atacks, stroke, diabetes, falls, autoimmune disease, and all-cause mortality.
• The article recommends taking a Vitamin-D supplement, as it is difficult to get the recommended amount from food. The recommended dosage is 400 IU per day for people under 60 and 800-1000 IU per day for people over 60.
• Recommended calcium intake is 1000 mg/day for people under 50, and 1200 mg/day for people over 50.

Magnesium

• Many Americans have Type II diabetes, including 25% of people over 60.
• Diabetes greatly increases the risk of stroke, heart disease, blindness, kidney failure, nervous system damage, and limb amputations.
• While excess body fat, lack of exercise, and poor eating habits are the major risk factors for Type II diabetes, a lack of magnesium can be a contributing factor. Large studies have shown that high magnesium intake is associated with reduced incidence of diabetes.
• Fruits, vegetables, whole grains, nuts and beans are plentiful in magnesium. 

Vitamin B-12

• Low levels of Vitamin B-12 are associated with poorer memory and mental ability. Yet the ability to absorb this vitamin from food decreases as we age.
• A low Vitamin B-12 level in combination with a high levels of folic acid is strongly associated with cognitive impairment.
• The article recommends taking a multivitamin containing at least 6 micrograms of Vitamin B-12 or a B-12 supplement containing up to 100 micrograms of B-12, and being careful not to get too much folic acid from vitamins and fortified cereals.

Heart Attack Deaths in the U.S. Have Dropped Sharply

In the Harvard Health Letter, vol 35, no. 10, August 2010, and article appeared entitled, "Is the heart attack going out of style?". It stated that, based on Medicare data, the U.S. heart-attack hospitalization rate declined by 23% from 2002 to 2007. Also, a study based on 3 million members of a northern California health plan showed a 24% drop in heart attack hospitalizations between 1999 and 2008. While an increasing number of people are diagnosed with heart disease, fewer are dying from it - heart attack deaths have been declining in the U.S. for the past 40 years.

The article conjectures that, "Maybe decades of efforts to eat right and exercise more, stop smoking, lower LDL cholesterol levels, and control blood pressure are working." This appears only partially true. Yes, fewer Americans smoke, and Lipitor, a medication for reducing LDL and total cholesterol, is the most prescribed drug in the U.S. Many people are also taking blood pressure medication. Yet, there is little evidence that people are "eating right" as fast-food consumption and obesity continue to increase. Also, various national campaigns, such as the American College of Sports Medicine's Healthy People 2000, have failed dismally to get people to exercise more. Thus, it appears that the reduction in heart attacks is less due to anything that requires will power than to modern medicine. Another possible factor is reduced stress, as the economy was doing well over the study period. It remains to be seen what the recession and high unemployment rate will do to the heart attack rate. Hopefully, and emphasis on family and personal fulfillment and relationships will help keep stress to a minimum, even in the face of economic difficulties.

The reduction in heart attacks is encouraging, yet it would be even better if people became healthier through lifestyle changes such as exercise and good nutrition.