Weight loss after bariatric surgery can improve heart health

In overweight and obese people, fat often gets deposited into the midsection of the body. Large amounts of this belly fat can lead to unhealthy changes in a heart’s function and size. However, according to new findings presented at the American College of Surgeons Clinical Congress 2017, a bariatric surgical procedure, and the weight loss that follows it, actually may allow the heart to return to its natural shape and function.

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When a person lifts weights, pushing against resistance, their muscles eventually get bigger. The same is true for the heart muscle. When a person is overweight, the heart has to generate more force to pump even more blood throughout the body. This extra workload causes the heart muscle to grow bigger, but contrary to what some people think, a bigger heart muscle does not mean a stronger heart. In fact, the larger the heart, the less efficacious it is in fulfilling its functions.

“We know that obesity is the most prevalent disease in the United States. And that the cardiovascular system is significantly affected by this disease process,” said lead study author Raul J. Rosenthal, MD, FACS, chairman, Department of General Surgery at the Cleveland Clinic in Weston, Florida. “But we wanted to know to what degree the shape of the heart changes in someone who is obese, what the heart looks like in someone after having bariatric surgery and losing weight, and how that change in geometry affects heart functionality.” For this study, researchers at the Cleveland Clinic reviewed data on 51 obese men and women who underwent bariatric surgery between 2010 and 2015. The analysis included factors such as body mass index (BMI) and coexisting health problems. The average age of the patients was 61 years, and the average BMI was 40; approximately 100 pounds overweight.

To better understand the impact of a bariatric operation and weight loss on heart health, the researchers compared preoperative and postoperative echocardiography readings. An echocardiogram is an ultrasound of the heart that measures not only its size and geometry but also its function. An echocardiogram measures how much blood is in the heart, how much blood goes out of the heart, and how much blood remains in the heart. One year after bariatric surgery, the researchers found significant improvements in patients’ heart health. Nearly half of the patients had hearts that had gone back to their natural shape or geometry. They also found that there was a significant improvement in the size of the ventricles: On average these chambers of the heart decreased in size by 15.7 percent (left ventricle mass: 229 grams before surgery; 193 grams after surgery. Left ventricular wall diameter: 60.1 mm before surgery; 53.7 mm after surgery.)Related image

Larger chambers lose some of their pumping power. This loss means that more blood stays in the heart, and ultimately increases a person’s risk of heart failure. “When the size of the chambers gets bigger, and the walls of the heart get thicker, the blood flow to the heart is not as good, the functionality of the heart is not as good, and the heart itself doesn’t get enough blood,” Dr. Rosenthal said. “The whole body suffers because there is less blood going to your feet and to your toes and to your brain.” This study is the beginning of a series of studies that will be conducted by these researchers over the next few years. They will perform follow up studies to find out what the window is in which losing weight allows the heart to go back to its normal geometry.

“We don’t know if being obese for 20 years and having changes in your heart geometry is different from being obese for 10 years,” Dr. Rosenthal said. “The question is: Will the heart always come back to normal? It could be if you wait too long, the changes in your heart are irreversible.”

Adapted by: American College of Surgeons. “Weight loss after bariatric surgery can improve heart health: Significant improvements in heart shape and function can happen one year after an operation for weight loss.” ScienceDaily. ScienceDaily, 24 October 2017. <www.sciencedaily.com/releases/2017/10/171024232822.htm>

Nutritional Nugget

Take a walk instead! Replace a coffee break with a brisk 10-minute walk. Ask a friend or colleague to join you.

WOD Nugget

Relume: Relight or rekindle (a light, flame, etc.)

Inspirational Nugget

I smile because I have survived everything the world has thrown at me. I smile because when I was knocked down I got back up.

“Ego could be defined as whatever covers up basic goodness. From an experiential point of view, what is ego covering up? It’s covering up our experience of just being here, just fully being where we are so that we can relate with the immediacy of our experience. Egolessness is a state of mind that has complete confidence in the sacredness of the world. It is unconditional well-being, an unconditional joy that includes all the different qualities of our experience.”

~Pema ChÖdrÖn

 

 

Genetics may put a person at risk of high triglycerides, but adopting a healthy diet can help

Triglycerides, a type of fat in the blood, are essential for good health. However, having high triglycerides might increase a person’s risk of heart disease, and could be a sign of metabolic syndrome, a combination of high blood pressure, high blood sugar, and too much fat accumulation at the waist. People with metabolic syndrome have increased risks for heart disease, diabetes, and stroke.

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A new study from nutrition researchers at the University of Illinois shows that some individuals with variations of a “gene of interest” may be at an even higher risk of developing high triglycerides. Specifically, researchers looked at genetics and risk in a group of young Mexican adults. Despite genetic predisposition, the study shows that maintaining healthy body weight or changing diet can help reverse the risk. Katie Robinson, a former doctoral student in the U of I Division of Nutritional Sciences and fellow of the I-TOPP program, explains that the study is a collaboration between the University of Illinois and the Autonomous University of San Luis Potosi in Mexico (UASLP), also known as UP AMIGOS. “Obesity is a growing problem in the U.S. and Mexico. In the U.S., obesity affects over a third of our population. We’re concerned because obesity is associated with other diseases such as diabetes, heart disease, and high triglycerides,” Robinson explains. Compared to Caucasian groups, Hispanics in the U.S. have higher rates of type 2 diabetes and other obesity-related diseases. Of all Hispanic subgroups, those of Mexican heritage have one of the highest risks for obesity and associated diseases.”

The UP AMIGOS project addresses genetic and environmental factors associated with obesity and related conditions among younger adults in Mexico. “A lot of existing data are from Caucasian cohorts, which means we needed to replicate and better understand those findings in groups with different ethnicities. That’s the main goal of the UP AMIGOS project. “It was a great opportunity that we were able to look at this rich data set from young Mexican adults because we know that this population has a greater likelihood of developing not only obesity but also high triglycerides and diabetes,” Robinson adds. For the current study, Robinson was interested in a protein made in the liver called fetuin-A (FetA). “It’s an interesting marker connecting inflammation with obesity and its associated diseases,” she says. “FetA is a protein that is released from adipose tissue and also the liver. We know FetA is integral to insulin sensitivity, and that’s where most of the research has been done to look at its function.

“We also know that FetA is elevated in obesity and diabetes. Therefore, we were interested in looking at the genetic implication. If there are alterations or single nucleotide polymorphisms within the gene that codes for FetA, does that change somebody’s risk for obesity or the associated diseases?” To answer that, the researchers looked at bloodwork from 641 young Mexican adults to analyze biomarkers and genotypes. They also checked body mass index (BMI), took measurements of fasting glucose levels, and had the participants report on their dietary habits. From the genotyping, they were explicitly looking for occurrences of two mutations of the gene, AHSG, a gene that influences the protein FetA. They were interested in the association of those gene mutations with dietary intake, weight, and also biological markers of health.

The AHSG polymorphisms were found to be associated with triglycerides. Robinson explains the most critical finding is that one of these polymorphisms, or mutations, was associated with higher circulating triglycerides, but that correlation was very dependent on BMI and dietary intake, the relationship was exaggerated in individuals who were overweight. “So with an elevated BMI, we saw greater disorder within those carrying the risk genotype. But if these individuals who had the high-risk AHSG genotype had a lower BMI, their triglycerides were lower. It suggests that even if you carry the high-risk genotype, you don’t have a greater risk of high triglycerides if you can maintain a normal BMI or a lower BMI, which I think is a positive finding when we look at genetics.”

Robinson says diet also played a role in higher triglycerides. “Higher carbohydrate intake, specifically sugar or sucrose intake, was associated with elevated triglycerides. This association was mainly in one genotype group. The thought was perhaps these individuals are more sensitive to certain diets than the other genotype groups.” Regardless of genotype, elevated BMI was associated with higher triglycerides. Due to the relationship between FetA and diabetes, the researchers also wanted to see if there was an association with AHSG mutations and glucose, but surprisingly, they did not find any.

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While the study looked at relatively healthy young adults in a Mexican population, results were different than what has been observed in previous research from Caucasian groups. Robinson explains that they might have seen different results if they had looked at older Mexican adults with poorer health. Some good news from the study’s findings is that maintaining a healthy body weight often can overcome the effects of gene related metabolic disease and type 2 diabetes. “We know that genes aren’t everything,” Robinson says. “There are a lot of things we can do, behaviorally, to change our individual risk. It’s a silver lining in our research. We can’t modify our genetics, but we can modify our epigenomes and some behaviors. You can still have positive health outcomes.”

The results are also significant for the future of developing personalized nutrition as interventions for disease, Robinson says. “In practical terms, it would be ideal to start by understanding someone’s basic biology, which may influence how they’re metabolizing and utilizing the nutrients they are eating. It would be great to bring people in, find out where their biology is at, and then tailor a diet for them, but we need a lot more research before we get to that point.” Margarita Teran-Garcia, assistant professor in the Division of Nutritional Sciences and the Department of Human Development and Family Studies at U of I adds, “In order to advance the full potential of precision medical and nutritional sciences, there is a need to invest and create new sustained resources, financial and technological, to build the evidence base needed to guide clinical practice and strategic planning in public health.”

Adapted from:  Katie N. Robinson, Itzel Vazquez-Vidal, Courtney Marques, Flavia Cristina Drumond Andrade, Celia Aradillas-Garcia, Margarita Teran-Garcia. Circulating Triglycerides and the Association of Triglycerides with Dietary Intake Are Altered by Alpha-2-Heremans-Schmid Glycoprotein PolymorphismsJournal of Nutrigenetics and Nutrigenomics, 2017; 75 DOI: 10.1159/00047

Nutrition Nugget

Model healthy habits! Adults who choose low-fat or fat-free milk or yogurt show kids that dairy is an important part of a healthy eating style. When kids model this behavior, their growing bones will thank you.

WOD Nugget

Bitts: A pair of posts on the deck of a ship for fastening mooring lines or cables.

Inspiration Nugget

Sometimes all it takes is one small prayer to change someone's life.

 “When you come from the view that you’re fundamentally good rather than fundamentally flawed, as you see yourself speak or act out, as you see yourself repress, you will have a growing understanding that you’re not a bad person who needs to shape up but a good person with temporary, malleable habits that are causing you a lot of suffering. And then, in that spirit, you can become very familiar with these temporary but strongly embedded habits. We all carry around trunk loads of old habits, but very fortunately for us, they’re removable.”

~Pema ChÖdrÖn

 

 

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There are plenty of reasons to exercise and plenty of reasons to limit sugar, but the truth is, neither would be enough to stem the obesity epidemic. Studies show that exercise, despite all its benefits, cannot compensate for poor eating habits when it comes to weight loss. For the most part, too much sugar and too little exercise sugarcoat the real issue at hand: We’re eating meat and dairy products in quantities that our grandparents never imagined. Obesity was all but unheard of a century ago in the United States. By 1970, about 11 percent of the population qualified as obese. Today, that number stands at 36 percent. So what happened?

Since 1970, our overall energy intake has risen by about 500 calories per day. Where are most of these extra calories coming from? The bulk is from meat, eggs, dairy products, and added fats, which account for an extra 287 calories every day. That adds up to about four extra pounds per year. Let’s rewind another 60 years. Compared to 1909, we now consume 60 more pounds of meat per person each year. Cheese consumption has soared from just four pounds per person in 1909 to more than 30 pounds today, making it a leading source of saturated fat in Americans’ diets.

Eating 100 more pounds of meat and cheese – along with saturated fat and cholesterol – every year has, not surprisingly, only made us gain weight and get sick. Decades of science confirm that our waistlines would benefit from simply moving the animal products off our plates. According to 15 major research studies, vegetarian diets consistently lead to weight loss, even without calorie restriction or exercise and long-term observational studies show that vegetarian—especially vegan—populations are the trimmest and healthiest on the planet.

It’s time to stop the sweet talk: Meat and dairy are the real drivers of the obesity epidemic, and setting them aside will help solve it.

Tip of the Day

Enjoy foods from many cultures. Combinations of herbs and spices often remind us of dishes from our own heritage or our favorite ethnic food. Add flavor to meals with herbs and spices, such as chili, garlic, ginger, basil, oregano, curry, cilantro or turmeric.

Daily Inspiration 

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Vegan Diets Protect Against Prostate Cancer

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A vegetarian diet lowers your risk for prostate cancer, according to a study published in the American Journal of Clinical Nutrition (November, 2015). Researchers compared several dietary patterns and cancer incidence rates for 26,346 participants from the Adventist Health Study-2. Those who followed a vegan diet were less likely to be obese and experienced a 35 percent lower prostate cancer risk than those following a nonvegetarian, lacto-ovo-vegetarian, pesco-vegetarian, or semi-vegetarian diet. Researchers suspect higher intakes of fiber, soy, and anti-inflammatory antioxidants from fruits and vegetables and lower intakes of saturated fat, animal protein, and serum insulin-like growth factor 1 from dairy products from a vegan diet contributed to lower cancer risk.

Tantamango-Bartley T, Knutsen SF, Knutsen R, et al. Are strict vegetarians protected against prostate cancer? Am J Clin Nutr. Published online November 11, 2015.

Tip of the Day

Prep in different ways! Did you know that it may take up to a dozen tries for a child to like a new food? Don’t give up. Try preparing the same food in different ways! They may like a vegetable cooked but not raw or vice versa.

Daily Inspiration 

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Persimmon Pear Salad

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Persimmons contain at least 20% of the daily value of vitamin C. These thin skinned fruits are an easy choice for salads and out-of-hand eating.

Slice 2 persimmons and 1 medium red pear into wedges. Toss 4 cups baby spinach with 1/2 cup crumbled feta; 4 tablespoons finely chopped toasted pecans; and fruit. Drizzle with 2 tablespoon of olive oil and 2 to 3 teaspoons of balsamic vinegar.

Makes 4 servings

Per Serving: 210 calories, 16 g fat (4 g sat), 16 g carbs, 250 mg sodium, 3 g fiber, 4 g protein

Tip of the Day 

Portion update! Today’s average bagel is twice the size is was 20 years ago. That also means twice the number of calories. Keep portion size in mind at your next meal to cut down on calories.

Daily Inspiration 

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Date-Oatmeal Stuffed Apples

Dates: Rich and sweet, they are a good source of fiber, magnesium, potassium, and health-promoting polyphenols.

 

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Mix 1/2 cup cooked cold oatmeal; 1/4 cup toasted chopped hazelnuts; 5 chopped, pitted dates; 1 tablespoon maple syrup; 1/4 teaspoon nutmeg; and a pinch of salt. Use a melon baller to make a cavity three quarters deep in each of 4 Rome apples and pack with filling. Place apples in a baking dish, pour 1/2 cup apple juice around them, cover with foil, and bake at 375 until tender, 40 to 70 minutes. Top with a teaspoon of heavy whipping cream.

Makes 4 servings

Per Serving: 270 cal, 6 g fat (1 g sat), 58 g carbs, 40 mg sodium, 8 g fiber, 3 g protein

Tip of the Day

Up for a challenge? Challenge yourself to make half your grains whole. Mix white rice with equal parts brown rice and enjoy with a veggie-filled chicken stir-fry. Serve with a side of fruit and a glass of milk to include all 5 food groups.

Daily Inspiration

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Easy Vegetarian Crock-Pot Chili

Serves: 8

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1 can Black Beans, rinsed and drained

1 can Kidney Beans, rinsed and drained

1 can Garbanzo Beans, rinsed and drained

2 cans Diced tomatoes

2 Tbsp. Tomato Paste

1 cp. Frozen Corn

1 large Onion, chopped

1 Green Pepper, chopped

3 Carrots, peeled and chopped

3 cloves of garlic, crushed

1 tsp. Cumin

Dash of Tabasco Sauce

Dash of Worcestershire Sauce

1 qt. low sodium Vegetable Broth

1/4 tsp. Salt or to taste

Place all ingredients in a large slow-cooker and cook on low for 6-8 hours or on high for 2-4 hours.

Nutrition Facts Per Serving: 

Calories 220, Fat 1.5g, Saturated Fat 0g, Carbohydrate 42g, Fiber 12g, Protein 11g, Sodium 620mg

Tip of the Day

Are you food safe? Use a food thermometer when cooking. A food thermometer should be used to ensure that food is cooked and held at safe temperatures until eaten.

Daily Inspiration 

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