A new study has claimed that much of the blame for the current obesity epidemic lies on modern dietary patterns characterised by excessive consumption of foods with a high glycemic load: in particular, processed, rapidly digestible carbohydrates.
These foods cause hormonal responses that fundamentally change our metabolism, driving fat storage, weight gain, and obesity. The findings of the study were published in ‘The American Journal of Clinical Nutrition’.
Statistics from the Centers for Disease Control and Prevention (CDC) show that obesity affects more than 40 per cent of American adults, placing them at higher risk for heart disease, stroke, type 2 diabetes, and certain types of cancer.
The USDA’s Dietary Guidelines for Americans 2020 – 2025 further says that losing weight “requires adults to reduce the number of calories they get from foods and beverages and increase the amount expended through physical activity.”
This approach to weight management is based on the century-old energy balance model which states that weight gain is caused by consuming more energy than we expend. In today’s world, surrounded by highly palatable, heavily marketed, cheap processed foods, it’s easy for people to eat more calories than they need, an imbalance that is further exacerbated by today’s sedentary lifestyles.
Overeating, coupled with insufficient physical activity, is driving the obesity epidemic. On the other hand, despite decades of public health messaging exhorting people to eat less and exercise more, rates of obesity and obesity-related diseases have steadily risen.
The study points to fundamental flaws in the energy balance model, arguing that an alternate model, the carbohydrate-insulin model, better explains obesity and weight gain. Moreover, the carbohydrate-insulin model points the way to more effective, long-lasting weight management strategies.
According to lead author Dr David Ludwig, Endocrinologist at Boston Children’s Hospital and Professor at Harvard Medical School, the energy balance model doesn’t help us understand the biological causes of weight gain: “During a growth spurt, for instance, adolescents may increase food intake by 1,000 calories a day. But does their overeating cause the growth spurt or does the growth spurt cause the adolescent to get hungry and overeat?”
In contrast to the energy balance model, the carbohydrate-insulin model makes a bold claim: overeating isn’t the main cause of obesity.
Instead, the carbohydrate-insulin model lays much of the blame for the current obesity epidemic on modern dietary patterns characterised by excessive consumption of foods with a high glycemic load: in particular, processed, rapidly digestible carbohydrates.
When we eat highly processed carbohydrates, the body increases insulin secretion and suppresses glucagon secretion. This, in turn, signals fat cells to store more calories, leaving fewer calories available to fuel muscles and other metabolically active tissues.
The brain perceives that the body isn’t getting enough energy, which, in turn, leads to feelings of hunger. In addition, metabolism may slow down in the body’s attempt to conserve fuel. Thus, we tend to remain hungry, even as we continue to gain excess fat.
To understand the obesity epidemic, we need to consider not only how much we’re eating, but also how the foods we eat affect our hormones and metabolism. With its assertion that all calories are alike to the body, the energy balance model misses this critical piece of the puzzle.
While the carbohydrate-insulin model is not new–its origins date to the early 1900s–The American Journal of Clinical Nutrition perspective is the most comprehensive formulation of this model to date, authored by a team of 17 internationally recognised scientists, clinical researchers, and public health experts.
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STUDY FINDS WHOLE FAT DAIRY AS GOOD AS LOW FAT FOR KIDS
A team of researchers from Edith Cowan University has found that when it comes to your kids, whole fat milk is as good as low-fat milk.
The study has been published in the ‘American Journal of Clinical Nutrition’. It suggested the current public health advice recommending children over the age of two consume low-fat dairy products may need to be revised.
ECU’s Associate Professor Therese O’Sullivan led the investigation into the consumption of full-fat dairy products in children as part of the Milky Way study.
Over a three-month period, 49 healthy children aged four to six were randomly allocated to receive either whole-fat or low-fat dairy products in place of their normal dairy intake.
Dairy products were home delivered every fortnight in plain packaging at no cost to the participants, to ensure purchase price wasn’t a factor.
Neither group knew whether they were consuming whole-fat or low-fat dairy, while any leftover products were weighed each fortnight to assess the children’s overall intake.
For the first time, researchers comprehensively measured the children’s obesity, body composition, blood pressure, and blood biomarkers to monitor the effects of their dairy consumption. Regardless of whether they were consuming whole-fat or low-fat dairy, both groups of children took in similar amounts of calories.
Although children consuming low-fat dairy took in fewer calories and fat from dairy, they naturally turned to other foods and drinks to make up for this difference.
Professor O’Sullivan said the findings showed no significant differences between the groups’ obesity or cardiovascular health.
“It had previously been thought young children would benefit from low-fat dairy products due to their lower levels of saturated fats and lower density of energy, in turn helping avoid obesity and risk of associated cardiometabolic diseases,” she said.
“Our results suggest healthy children can safely consume whole-fat dairy products without increased obesity or adverse cardiometabolic effects. With consideration of our results and previous research, future revisions of dietary guidelines should consider recommending children aged two and over can consume either whole fat or reduced-fat dairy,” she added.
Dietitian and PhD candidate on the study Analise Nicholl said that this would make life easier for parents.
“This evidence-based approach would help simplify parents’ dairy choices and allow children to consume dairy according to their individual preference,” Analise said.
Medical training takes less mental toll than a decade ago: Study
It took more than a decade for researchers to track the mental health of medical interns in their most stressful time of training. However, it has been found that things have gotten better now.
This research was published in the ‘Annals of Internal Medicine Journal’. But those first-year residents, or interns, still have a sizable risk of developing depression. And many who do still don’t seek help.
The jump in depression scored over the course of the first post-medical school year has gotten 25% smaller from 2007 to 2019, according to the study of nearly 17,000 new doctors led by a team from the University of Michigan Medical School.
To help understand potential drivers of the effect, the team explored individual and residency program factors previously shown to be linked to depression among training doctors. The study suggested, but can’t prove, that reduced work hours, slightly increased sleep, more feedback from supervisors and increased use of mental health care contributed to the change in depressive symptoms over time. Data from the participants showed significant changes in all of these measures.
The findings came from the Intern Health Study, which has used wearable activity trackers, mobile apps, surveys and genetic tests to study medical interns at hundreds of teaching hospitals.
In addition to tracking a group with a known high risk of depression, the study provided a way to study the effects of intense, prolonged stress more generally.
That’s why the new results could have impacted beyond medical training. Other stressful jobs and long-term stressful situations might also benefit from the increased attention to reducing depression-related stressors that the graduate medical education community has focused on in recent years.
“The Intern Health Study offers a unique dataset for us to study the trend of this population’s mental health over a long time span,” said Yu Fang, M.S.E., the study’s first author and a researcher at the Michigan Neuroscience Institute.
“The story we have learned from these data could help to make strategic plans in shaping a better medical internship experience in the future,” Fang added.
Srijan Sen, M.D., PhD, the leader of the Intern Health Study, said, “Given that depression rates are still very high, compared to the general population, we are hopeful that the drivers of improvement over the past 13 years can help guide areas to focus on to catalyse even more improvement going forward.”
Sen is director of the U-M Frances and Kenneth Eisenberg and Family Depression Center, and a professor in MNI and the Department of Psychiatry at Michigan Medicine.
The reduction in the size of the depression-score jump came despite the fact that interns in later years were more likely to have risk factors for depression, including a history of the condition.
The data showed that interns’ work hours dropped by 11 per cent over the 13-year period, sleep hours per day went up nearly 5 per cent, and the percentage of residents with current depression who were getting professional help went from 14 per cent to 38 per cent.
Over the course of the 13 years studied, female interns experienced a more pronounced reduction in the magnitude of depression symptom increases across the intern year, and they were much more likely to seek mental health care. The percentage of interns who were female also increased over the 13-year study period.
The same was true for interns in non-surgical fields compared with those pursuing training in surgery or another surgery-based speciality; the reduction in work hours was larger in non-surgical interns.
The study did not show any measurable difference between those whose intern year included the first months of the Covid-19 pandemic and those who trained before. Other research from the Intern Health Study is looking at the impacts of the pandemic, including one already-published study about interns taking part in the study in China.
Covid-19 during pregnancy doesn’t harm baby’s brain: Study
Covid-19 of mild to moderate severity in pregnant women appears to have no effect on the brain of the developing fetus, according to a recent study.
The study was presented at the annual meeting of the Radiological Society of North America (RSNA). Two years into the pandemic, there is evidence that pregnant women are more vulnerable to the SARS-CoV-2 virus that causes Covid-19. However, little is known about the possible consequences for an unborn child if the mother is infected during pregnancy.
The likelihood and impact of vertical transmission, meaning the passage of the virus from the mother to the fetus, remains unclear.
“Women infected with SARS-CoV-2 during pregnancy are concerned that the virus may affect the development of their unborn child, as is the case with some other viral infections,” said study senior author Sophia Stocklein, M.D., from the Department of Radiology at Ludwig Maximilian University of Munich, in Germany. “So far, although there are a few reports of vertical transmission to the fetus, the exact risk and impact remain largely unclear.
The aim of our study was to fill this gap in knowledge regarding the impact of maternal SARS-CoV-2 infection on fetal brain development.”
Dr Stocklein and colleagues used fetal MRI to study 33 patients with Covid-19 infection during pregnancy. The patients were roughly 28 weeks into their pregnancies, on average, with symptom onset occurring at a mean of just over 18 weeks into the pregnancy. The most common maternal symptoms were loss or a reduced sense of smell and taste, dry cough, fever and shortness of breath.
Two board-certified radiologists with several years of experience in fetal MRI evaluated the scans. They found that the brain development in the assessed areas was age-appropriate in all fetuses. There were no findings indicative of infection of the fetal brain.
“In our study, there was no evidence that a maternal SARS-CoV-2 infection has any effect on the brain development of the unborn child,” Dr Stocklein said. “This fact should help to reassure affected parents.”
Dr Stocklein cautioned that only mothers with mild to moderate symptoms and without hospitalisation were included in the study.
“Since the impact of severe infection on brain development in the fetus has not been conclusively determined, active protection against SARS-CoV-2 infection during pregnancy remains important,” she said.
As part of that protection, the Centers for Disease Control and Prevention (CDC) recommends vaccination for all people ages 12 and older, including women who are pregnant or thinking about getting pregnant. The CDC notes that the vaccine can protect against severe illness.
“So far, vaccination is the most promising protection against Covid-19,” Dr Stocklein said. “Any potential side effects are manageable, even in pregnant women. Therefore, despite the encouraging results of our study, pregnant women should strongly consider vaccination.”
The researchers will be following the patients over the next five years, including detailed neonatal assessment, as well as assessment of neurological development.
WHY HEART ATTACKS IN YOUNG PEOPLE ARE ON THE RISE
Let’s find out the major risk factors of having a heart attack at a young age.
37-year-old Jasbir Singh Hanspal had no signs of co-morbidities but began experiencing severe chest pain. When he was brought to Fortis Hospital, Kalyan, the doctor confirmed that he had suffered a heart attack and needed urgent Angioplasty; but just when the team started preparing him for the procedure, his heart stopped functioning. Without wasting a single minute, the doctors revived him and began the procedure where they diagnosed that despite no signs of co-morbidities the patient had a total block in one of the arteries, and diffused fat deposition in all other arteries that had caused the heart to collapse. Despite the great risk, doctors successfully saved his life. A few days later the doctors discovered that Hanspal had undiagnosed Diabetes and higher levels of Cholesterol that had impacted his heart. The patient is now recovering and is on Diabetes medication.
Similarly, 22-year-old Nilesh (name changed) suddenly suffered a heart attack. While he was brought to Fortis Hospital, Kalyan, just in time that saved his life, further investigations by doctors at the hospital revealed that he had a cardiac abnormity by birth which was never unravelled before. Nilesh also consumed tobacco regularly which caused his condition to aggravate. He was treated with a clot-buster injection in view of clotting and his age.
RISING RISK OF HEART ATTACKS IN YOUNG PEOPLE
These are just a few examples of the many cases of heart attacks among young Indians that doctors have experienced. The number is constantly mounting. Initially, these increasing number of cardiac events among young and active people puzzled experts, but now the picture seems clearer. Blame it on sedentary lifestyle and health negligence. Key risk factors of having a heart attack at a young age include:
• Substance abuse or excessive alcohol use
• High blood pressure
• High cholesterol levels
• Lack of physical activity
• Poor diet
WHY PRIMORDIAL PREVENTION IS KEY?
Primordial prevention is necessary. This means trying to prevent the progression of the heart attack risk factors themselves. This includes trying to change the social and environmental conditions that could develop and progress risk factors. These are things that we have control over such as exercising, eating nutritious foods, not smoking, managing stress and blood pressure. Primordial prevention also includes education about what behaviours put you at risk for Cardiovascular Disease (CVD), along with the above-mentioned risk factors, the list includes:
• Family history of Cardiovascular Disease
• Sedentary lifestyle
Now, the fact remains that heart attacks can happen to anyone – but the risk is especially high when genetics come into play. Primordial and primary prevention is crucial for those with a family history of heart disease. A person’s hereditary risk of heart disease is defined by having a first-degree male relative (like father, brother or son) under the age of 55 years with a Heart Attack or Stroke history, or a first-degree female relative (like mother, sister or daughter) under the age of 65 years with a Heart Attack or Stroke history.
In the end, our lifestyles need to change. Not enough young people take their risk factors seriously and that’s dangerous. We need to be aggressive about risk factor modification and build a society that is not only informed but empowered to resolve and reverse risk factors.
The writer is Senior Consultant-Interventional Cardiology, Fortis Hospital, Kalyan.
STRESS LINKED TO CROHN’S DISEASE FLARE-UPS: STUDY
According to new research by McMaster University, it is possible that psychological stress could be associated with Crohn’s disease flare-ups.
The study has been published in the ‘Nature Communications Journal’. Researchers using mouse models found that stress hormones suppressed the innate immune system that normally protected the gut from invasive Enterobacteriaceae, a group of bacteria including E. coli that has been linked to Crohn’s disease.
The key to innate immunity is the protective barrier of epithelial cells in the gut, which rely on molecular signals from immune cells to keep out harmful microbes, repair the cell wall and secrete mucus. Without properly functioning immune cells, the epithelial cellular wall can break down, allowing microbes associated with Crohn’s disease to invade the gut and trigger symptom flare-ups.
“The main takeaway is that psychological stress impedes the body’s ability to fight off gut bacteria that may be implicated in Crohn’s disease. Innate immunity is designed to protect us from microbes that do not belong in the gut, like harmful bacteria,” said senior author Brian Coombes, professor and chair of biochemistry and biomedical sciences at McMaster.
“When our innate immune system functions properly, it prevents harmful bacteria from colonizing us, but when it breaks down, it leaves an opening for pathogens to colonize locations they normally cannot and cause illness,” he added.
Coombes said that removing stress hormones in the mouse models restored proper function to immune cells and epithelial cells, blocking the invasion of harmful microbes.
While this discovery could lead to new treatments for Crohn’s disease, Coombes emphasized these findings are still at the pre-clinical stage and more work needs to be done.
“The more we know about what triggers Crohn’s disease, the closer we come to new treatments and potentially even disease prevention,” said Coombes.
Crohn’s disease is an inflammatory condition that causes inflammation, ulcers and scarring in the digestive system. While its root cause is still not fully understood, Coombes said patients with the disease often have an altered gut microbiome dominated by Enterobacteriaceae like E. coli.
The Coombes lab is a part of the Michael G. DeGroote Institute for Infectious Disease Research and the Farncombe Family Digestive Health Research Institute based at McMaster University. External funding for the study was provided by the Canadian Institutes of Health Research and Crohn’s and Colitis Canada.
COVID-19 LINKED TO HEART INFLAMMATION IN COLLEGE ATHLETES
According to a new study, a small but significant percentage of college athletes with COVID-19 develop myocarditis, a potentially dangerous inflammation of the heart muscle.
The findings of the study were presented at the annual meeting of the Radiological Society of North America (RSNA). Myocarditis, which typically occurs as a result of a bacterial or viral infection, can affect the heart’s rhythm and ability to pump and often leaves behind lasting damage in the form of scarring to the heart muscle. It has been linked to as many as 20 per cent of sudden deaths in young athletes. The COVID-19 pandemic raised concerns over an increased incidence of the condition in student-athletes.
For the new study, clinicians at schools in the highly competitive Big Ten athletic conference collaborated to collect data on the frequency of myocarditis in student-athletes recovering from COVID-19 infection. Conference officials had required all athletes who had COVID-19 to get a series of cardiac tests before returning to play, providing a unique opportunity for researchers to collect data on the athletes’ cardiac status.
Jean Jeudy, MD, professor and radiologist at the University of Maryland School of Medicine in Baltimore, serves as the cardiac MRI core leader for the Big Ten Cardiac Registry. This registry oversaw the collection of all the data from the individual schools of the Big Ten conference.
Dr Jeudy reviewed the results of 1,597 cardiac MRI exams collected at the 13 participating schools. There was no selection bias for cardiac MRI, as all COVID-positive athletes underwent a complete cardiac battery of tests including cardiac MRI, echocardiogram, ECG and blood tests, as well as a complete medical history.
Thirty-seven of the athletes, or 2.3 per cent, were diagnosed with COVID-19 myocarditis, a percentage on par with the incidence of myocarditis in the general population. However, an alarmingly high proportion of myocarditis cases were found in athletes with no clinical symptoms. Twenty of the patients with COVID-19 myocarditis (54 per cent) had neither cardiac symptoms nor cardiac testing abnormalities. Only cardiac MRI identified the problem.
“Testing patients for clinical symptoms of myocarditis only captured a small percentage of all patients who had myocardial inflammation. Cardiac MRI for all athletes yielded a 7.4-fold increase in detection,” Dr Jeudy said.
The implications of post-COVID-19 myocardial injury detected by cardiac MRI are still unknown.
“The main issue is the presence of persistent inflammation and/or myocardial scar. Each of these can be an underlying foundation for additional damage and increased risk of arrhythmia,” Dr Jeudy added.
As part of the study, Dr Jeudy and colleagues continue to add to the Big Ten Cardiac Registry to gain more understanding.
“We still don’t know the long-term effects. Some athletes had issues that were resolved within a month, but we also have athletes with continued abnormalities on their MRI as a result of their initial injury and scarring. There are a lot of chronic issues with COVID-19 that we need to know more about, and hopefully, this registry can be one of the major parts of getting that information,” Dr Jeudy explained.
The registry will allow researchers to look beyond the presence of abnormalities and study things like changes in exercise function over time.
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