Pulse of UTMC
My interest in prevention of cardiovascular diseases started well before I started my Masters degree at UT in Exercise Physiology focusing specifically in cardiopulmonary physiology. Below is a current illustration of our nation’s current debt and assets. The numbers are absolutely staggering to say the least. So… what exactly is the value of cardiovascular disease prevention, and will the savings from prevention make a difference?
Chronic illnesses such as diabetes, cancer and heart disease and other underlying causes such as obesity and tobacco use affect more than 130 million people, nearly half the population of the US. This burden consumes 75% of health care spending or $1.5 trillion annually… Now we’re talking!! If you still need a bit of convincing that prevention is best, the US spends 96% of Medicare dollars and 83% of Medicaid dollars on people with chronic conditions. High chronic disease and obesity rates are annually responsible for over $1 trillion in lost productivity in the workplace. The direct and indirect costs of CVD in the United States have been projected by the American Heart Association to increase from $272.5 and $171.7 billion in 2010 to $818.1 and $275.8 billion in 2030, respectively. The estimated cost of diabetes mellitus in the United States in 2007 was $174 billion, with 28% of expenditures attributed to cardiovascular complications of diabetes mellitus. Thus, most employers have invested in prevention wellness programs with positive results: (IBM has saved more than $175 million utilizing these programs, resulting in health care premiums that are 6-15% below industry averages. The CDC reported that for every dollar spent on prevention, $18.40 is saved. A study based on a simulation model found that for every $1 invested in building parks, and recreational areas such as trails, nearly $3 in medical cost savings may be achieved. A recent meta-analysis showed that medical costs fell by $3.27 and absenteeism costs fell by $2.73 for every dollar spent on worksite wellness programs.
When comparing the investment of prevention with the detriment of disease, one can see that it is simply a NO-BRAINER -that if together, we started to make healthy choices it would make a huge positive impact on our current economic situation!
(Weintraub et al., 2011)
Devol R, Bedroussian A. An Unhealthy America: The Economic Burden of Chronic Disease. The Milken Institute. October 2007. Available at: www.chronicdiseaseimpact.com .
More program examples are available online at: www.fightchronicdisease.org/promisingpractices and www.prevent.org/lbe .
Full program description available at: http://promisingpractices.fightchronicdisease.org/programs/detail/ibm .
Full program description available at: http://promisingpractices.fightchronicdisease.org/programs/detail/heath_care_university
Weintraub, W. S., Daniels, S. R., Burke, L. E., Franklin, B. A., Goff, D. C., Jr., Hayman, L. L., et al. (2011). Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation, 124(8), 967-990.
Summer is my favorite time of the year simply because it is warm and the sunlight makes me feel good. In the winter, the sunlight frequents us much less often- but does that affect us?
On average, humans used to spend at least half a day exposed to sunlight before electricity. Nowadays, exposure to sunlight is highly discouraged for fear of skin cancer and modern lifestyles are built around spending long hours inside exposed to artificial light. There is evidence that Ultraviolet Radiation (UVR) in the form of sunlight is a significant factor for non-melanoma and melanoma skin cancers in pale skinned people. Since our skin is a very large organ, about two square meters in an average adult male, exposure to the sun- whether risky or beneficial will impact us significantly. Similar to stroke, rates of acute coronary syndromes (including unstable angina, acute myocardial infarction, atrial fibrillation and sudden cardiac death) are highest in the winter months with shorter hours of sunlight.
Two benefits of sunlight:
Vitamin D: Vitamin D is formed when ultraviolet B (UVB) hits the skin and mediates photolysis of 7-dehydrocholesterol in the skin.
Melatonin: Melatonin is produced from serotonin by the pineal gland located in the center of the brain during periods of darkness, and its release is suppressed as a function of visible light intensity sensed through ocular photoreceptors.
In the 1970’s it was observed in several studies that people had consistently lower blood pressure in the summer than in the winter. It was found that the prevalence of mean population diastolic and systolic blood pressures correlate directly with latitude, being higher in populations living further from the equator. Recent studies have also confirmed this by demonstrating that biologically relevant doses of UVA lead to a sustained reduction in blood pressure. With a reduction in blood pressure, and a 20 mmHg lower systolic blood pressure- this leads to a two-fold reduction in overall mortality in both men and women aged 40-69 years. With this in mind, moderate exposure to sunlight may also reduce the economic burden of CVD. One study estimated this amount to be $519 Billion for hypertension, heart disease, and stroke in the USA (Combined impact of healthcare costs and lost economic output).This could potentially translate into hundreds of thousands of person- years of life and $Billions saved each year- (What a convenient way to boost our economy!).
If you have read my past articles, you know that I am a fan of arginine and Nitric Oxide (NO). In a recent study, it was found that moderate exposure to sunlight may activate bound stores of NO in the skin and mobilize it to its bioactive form. Nitrites, a byproduct of NO has long been considered biologically inert at low concentrations, but is now known to not only dilate blood vessels on its own, but to protect organs against ischemia/ reperfusion. Skin bound NO stores are in equilibrium with circulating nitrite in un-irradiated individuals, and dietary-derived nitrite may therefore increase the skin “NO” reservoir. Nitrite and NO are generated on the skin surface by reduction of sweat nitrate and possibly the oxidation of ammonia. A recent study demonstrated that UVA irradiation can increase plasma nitrite levels by 40%. The adult cardiovascular system may be more susceptible to the beneficial effects of sunlight- related NO release compared to children considering that the demographic is transitioning to an ageing world population with enhanced CVD.
So……… Next time the sun hits your face and you feel its warmth- remember—It might be doing much more for you than you think!
Is sunlight good for our heart? (2010). European Heart Journal, 1-5.
The Christmas holiday is approaching quickly. As we pack up in the next couple of weeks, we will go back to our families and loved ones to spend time with them and share in the holiday spirit by giving gifts and enjoying the break from school.
Unfortunately everyone may not be as lucky as you. Every day at the Cherry Street Mission, there are over 700 meals served to people who arrived at Cherry Street, hopeless and homeless, sometimes through circumstances most of us can’t imagine, but often for reasons we can imagine all too well. An extended illness that racks up insurmountable debt. A sudden cutback at work that leaves one jobless without warning. The loss of a spouse or child that rocks one’s world off its foundation.
This year in Toledo, during the holidays there is expected to be a huge increase in the number of meals served each day. Unfortunately, people in desperate need of help will not be fed if there is not an increase in the amount of food donated to Cherry Street Mission. Below is a picture of the shelves at Cherry Street Mission this month. The GSA (Graduate Student Association) will be helping to collect canned fruit and veggies, canned meat of any kind, coffee, hot chocolate, toilet paper, razors and deodorant to help fill the shelves at Cherry Street Mission and hearts of those in need.
If you feel obligated to help, Please bring canned donations to the GSA office – Room (SU1509) on main campus or contact any of the GSA officers (http://www.utoledogsa.com/). Each and every item will help those in need this holiday. To volunteer at Cherry Street Mission over the holidays please visit http://www.cherrystreetmission.org/how-you-can-help/volunteer .
“We make a living by what we get. We make a life by what we give.”- Winston Churchill
One of my interests- to pursue in the near future is “metabolic cardiology”- learning to prevent and treat heart disease as well as maintain a healthy heart and vascular system.
The benefits of regular moderate intensity, non-exhaustive physical exercise has been known for a long time. Some of those benefits include a reduced risk of cardiovascular disease, cancer, diabetes and in general- a lower risk of all-cause of mortality. HOWEVER, recent research has shown us that these beneficial effects are lost with strenuous exercise.
In the past few years, strenuous sports such as ultra marathon running, cross- country running, and Ironman triathlons have become very popular around the world. This type of exercise causes structural damage to muscle cells indicated by muscle soreness and swelling, prolonged loss of muscle function and leakage of muscle proteins into the circulation. This type of exercise has been associated with high increases of free radicals, and pro-inflammatory mediators. Damage like this can be PREVENTED by optimizing nutrition and increasing dietary nutritional antioxidants.
The heart relies on energy substrates to keep the voltage high in the heart so that it can pump blood effectively and efficiently. If you have had a lot of damage to your heart through strenuous exercise, there is a good chance that your heart is not in “tip top shape”. Your heart has lost essential substrates that keep its energy up. If you have this type of damage, it’s like having a pocket full of coins, with a hole in the pocket- your continually losing coins (substrates)- the leakage of the energy molecule ATP!!
In a recent publication in the European Journal of Nutrition, scientists have shown that taking a natural supplement termed “CoQ10” or Ubiquinone can dramatically prevent inflammatory mediators and oxidative stress associated with strenuous exercise.
If you are not familiar with Ubiquinone, it is an electron carrier found in the electron transport chain- located on the inner wall of the mitochondria, that is used help generate (ATP)- The ENERGY MOLOCULE. Here is a short clip to get you up to speed………. http://www.youtube.com/watch?v=xbJ0nbzt5Kw
In this study- there were two groups, a control group that did not take CoQ10 and an experimental group that took CoQ10. The Experimental group took 150mg of CoQ10 through a span of 48 hours before a strenuous run. Both groups then participated in a run that was a combination between mountain running and ultra-endurance racing. They ran to the top of the “Sierra Nevada”, considered to be one of the hardest workout trials worldwide. It was a total of 50km and had an initial elevation of 640m to a peak elevation of 3,393 m- almost a continuous incline the whole 50km.
Results showed that after the run the group that took CoQ10 had a significant decrease in creatinine compared to the control group. The CoQ10 group also had significant reduction in the DNA expression of free radicals, a decrease in lipid peroxidation, a significant reduction in the expression of NADPH- one of the main sources of free radicals, a significant decrease in a whole array of molecules that promote inflammation and also found a significant increase in muscle triglyceride levels, which is good during exercise because it improves skeletal muscle activity and exercise capacity.
All of the effects seen from this study show a strong antioxidant defense and an increase in markers that lead to the maintenance of the cell and its integrity. Since I have read this article, I have talked to several cardiologists that also prescribe CoQ10 to their patients to help increase heart health. If you are interested in learning more about “metabolic cardiology” you would find the book- by Dr. Stephen Sinatra M.D, F.A.C.C, F.A.C.N, C.N.S “The Sinatra Solution” a great read!
Dı´az-Castro, J. (2011). Coenzyme Q10 supplementation ameliorates inflammatory signaling and oxidative stress associated with strenuous exercise. European Journal of Nutrition, 9.
Graduate students…. The time is here for our first Graduate Student Association (GSA) meeting. The GSA gives graduate students the opportunity to become great leaders, participate in a nationally recognized symposium, provides travel reimbursement money for those seeking funds to attend conferences or symposiums around the US, enables your voice and concerns to be heard at the administrative level at UT, provides professionalism services, gives you the chance to make friends with potential colleagues in different colleges at UT and perhaps most importantly gives you the opportunity to network with successful individuals and corporations in almost every aspect of study. We look forward to meeting and working with you!
Graduate students……………. Do you want to get involved and make a difference at the University of Toledo? Participating in the Graduate Student Association (GSA) may be the perfect opportunity for you! Over the past few years at the University of Toledo, the (GSA) has been rapidly growing and is seeking energetic and enthusiastic graduate students like you to get involved. The GSA provides critical tools to each graduate student that allows them to make the most of their studies and professional endeavors. The GSA gives graduate students the opportunity to become great leaders, participate in a nationally recognized symposium, provides travel reimbursement money for those seeking funds to attend conferences or symposiums around the US, enables your voice and concerns to be heard at the administrative level at UT, provides professionalism services, gives you the chance to make friends with potential colleagues in different colleges at UT and perhaps most importantly gives you the opportunity to network with successful individuals and corporations in almost every aspect of study.
Check out the new 2012-2013 officers: http://www.utoledogsa.com/officers
From a personal prospective……… the GSA has changed my graduate years in many ways. I decided to get involved in GSA in August 2011. As a graduate student, I have benefited from the GSA. This is an organization in which a small amount of effort on your part will benefit you in almost every aspect of your graduate program. I came to UT not knowing many students and having very few friends, as a result of participating in the GSA, I have made many friends from several different colleges at UT, many of whom I would have never met. I got to take advantage of the volunteering opportunities at UT such as at the Midwest Graduate Research Symposium (MGRS). This year, the MGRS will be in April 2013 with a goal of recruiting presenters from every graduate program that UT offers such as Sciences and Math, Business, Language and literature, Education, Engineering, HSHS, Law, Nursing, Pharmacy and Visual and Performing Arts.
If you are ambitious and looking to make the best of your graduate career at The University of Toledo, consider joining the Graduate Student Association. Don’t miss this opportunity to enhance your leadership skills and make connections with professionals in your field of study.
LOOK FOR US AT GRADUATE STUDENT ORIENTATION!!!
On behalf of The University of Toledo and the Graduate Student Association- Best of luck with your studies this year, we look forward to meeting and working with you.
Have you ever wanted to work out but just don’t have the energy to get started or maintain energy to complete the workout? The use of pre workout stimulating supplements has been on a rise, and continues to increase, with athletes and recreationally active humans endlessly seeking methods to improve their performance (Bloomer et al., 2010). Pre workout supplements are generally taken by athletes who want to improve their performance and extend their time to fatigue. They are also used to motivate (i.e. Stimulate) their ability to work out harder when they feel like they don’t have the energy to get started. The “pre-workout” class of supplements typically contain a combination of several (30+) ingredients, and usually contain stimulants (e.g., caffeine), energy-producing agents (e.g., creatine), agents that act as a hydrogen ion buffer (e.g., beta alanine) , protein recovery nutrience (e.g., amino acids), antioxidants, and nitric oxide precursors (e.g., arginine)(Bloomer, et al., 2010). It has been shown that dietary supplementation of NO either with pharmacological sodium nitrate or with nitrate-rich beetroot juice results in a significant decrease in Oxygen (O2) cost of submaximal cycling, knee extensor exercise and treadmill walking/ running (Lansley et al., 2011).
Nitric Oxide (NO) in particular is a powerful molecule. It is no wonder it gained widespread acknowledgment and was named “molecule of the year” in 1992. NO is essential to all humans, because its main function in the body is to maintain vascular tone. When NO is released, it also inhibits pro-atherogenic processes including Monocyte and platelet adhesion, oxidation of low density lipoproteins, synthesis of inflammatory cytokines, smooth muscle proliferation and migration and platelet aggregation displaying an antithrombotic and fibrinolytic function (Abdu, Elhadd, Pfeifer, & Clayton, 2001).
Cardiovascular disease is one of the top killers in the United States. In 2010, the prevalence of Coronary Heart Disease (CHD) was greatest among persons aged ≥65 years (19.8%), followed by those aged 45–64 years (7.1%) and those aged 18–44 years (1.2%)(“Prevalence of coronary heart disease–United States, 2006-2010,” 2011). As you age, the bioavailability of NO decreases in the arteries’ raising the probability that you will develop an endothelial dysfunction that could lead to a heart attack or atherosclerosis (clogging of the arteries). Although NO is found in many vegetables, green leafy vegetables and beetroot juice are a highly abundant source of nitrate (NO-3) (Vanhatalo, et al., 2010). The use of NO-3 is a possible mediating component for the cardiovascular health benefits associated with high vegetable consumption in a Mediterranean diet (Vanhatalo, et al., 2010). Eating vegetables will serve as an exogenous source of NO and decrease your chances of developing atherosclerosis and many other negative cardiovascular events.
I have been using a pre-workout supplement called “Nitric Oxide Synthase” since September 2011 to train for a triathlon that I am participating in this year. I feel it has been very effective in acting as an ergogenic aid for cardiovascular training, but it is my quest- before I finish my master’s degree to figure out whether it is ACTUALLY a legitimate ergogenic aid, or am I feeling a placebo effect? There are several studies that have shown promising effects of NO as a pre-workout supplement but much work is still needed in this area.
Abdu, T. A., Elhadd, T., Pfeifer, M., & Clayton, R. N. (2001). Endothelial dysfunction in endocrine disease. Trends Endocrinol Metab, 12(6), 257-265.
Bloomer, R. J., Williams, S. A., Canale, R. E., Farney, T. M., & Kabir, M. M. (2010). Acute effect of nitric oxide supplement on blood nitrate/nitrite and hemodynamic variables in resistance trained men. J Strength Cond Res, 24(10), 2587-2592.
Lansley, K. E., Winyard, P. G., Bailey, S. J., Vanhatalo, A., Wilkerson, D. P., Blackwell, J. R., et al. (2011). Acute dietary nitrate supplementation improves cycling time trial performance. Med Sci Sports Exerc, 43(6), 1125-1131.
Prevalence of coronary heart disease–United States, 2006-2010. (2011). MMWR Morb Mortal Wkly Rep, 60(40), 1377-1381.
Vanhatalo, A., Bailey, S. J., Blackwell, J. R., DiMenna, F. J., Pavey, T. G., Wilkerson, D. P., et al. (2010). Acute and chronic effects of dietary nitrate supplementation on blood pressure and the physiological responses to moderate-intensity and incremental exercise. Am J Physiol Regul Integr Comp Physiol, 299(4), R1121-1131.
Recently, there has been a continual influx of published articles about big football players who face heart risks, especially, defensive linemen. In a recent study published in the American Journal of Cardiology, researchers following 3,400 NFL players who were active between 1959 and 1988, found that defensive linemen had a 42 percent higher risk of death from cardiovascular disease compared with U.S men in general. The study looked at 498 defensive linemen, and found that 41 of them had died of a cardiovascular cause.
One can calculate their Body Mass Index (BMI) by using the chart below and comparing their body weight to their height.
The chart is useful for finding a relatively healthy weight, although often in athletes, muscle mass can cause one’s BMI to exceed the healthy weight and put them in the category of “overweight” or “obese”. The physician who completed the study suggests that a high BMI based on muscle mass is not so bad.
Researchers explained that once athletes graduate from college, retire from the pros, or simply no longer exercise at the same activity level, often continue eating the same number of calories and gain weight, which causes health problems such as high blood pressure, unhealthy cholesterol levels and obesity. NFL players in the study who had a BMI of 30 or higher during their careers were twice as likely to die of cardiovascular causes as their lighter peers. The fact is: size is important, especially once the athletes are no longer in the game- the focus should be to “Lose the fat” in order to maintain the health.
The average NFL lineman during a training session consumes between 5,500 and 10,000 calories per day, while burning about 2,000 to 3,000 calories during the double session practice days. The American Heart Association recommends that the average person should eat about 2000 calories per day and aim for at least 30 minutes of moderate physical activity on most days of the week or, best of all, at least 30 minutes every day. The overall goal would be to spend as many calories per day as you consume. The average person burns about 77 calories per hour while they sleep and depending on your physical activity level, between 700- 1,200 calories during the day.
Most athletes enjoy a longer than average lifespan, but a study suggests that the bigger the athlete, the more likely that a long lifespan will be cut short by heart disease and cardiovascular complications. Of the 3,400 NFL players in the study, only 334 had died by 2007 which is about half the rate that would be expected based on the U.S norms- acting as evidence to support a longer lifespan in athletes. The best way to avoid becoming overweight as an athlete ages and becomes less and less active is to decrease the number of calories consumed, to adjust for a lifestyle with decreased activity levels.
American Heart Association. “Suggested servings from each food group.” American Heart Association. 14 Feb. 2012. The American Heart Association. 14 Feb. 2012. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Suggested-Servings-from-Each-Food-Group_UCM_318186_Article.jsp .
“BMI Chart – Body Mass Index Chart .” Body Shaping tips. Body Shaping Tips. 14 Feb. 2012. http://bodyshapingtips.com/body_mass/bmi_chart/ .
Norton, Amy . “More evidence big football players face heart risks.” Chicago Tribune. 8 Feb. 2012. The Chicago Tribune. 14 Feb. 2012. www.chicagotribune.com/sports/sns-rt-us-football-heart-riskstre8172gq-20120208,0,6204013.story
It is estimated that approximately 150 kcal is added to the average American diet each day due to the consumption of soft drinks. The consumption of sucrose-sweetened soft drinks has been associated with obesity, metabolic syndrome and cardiovascular disorders in observational, short and long term studies. Consuming soft drinks have become a part of the American diet. The average daily intake of soft drink in the United States is 0.5 L in all Americans, and 1.8 L in young American men between the ages of 12-29. It is estimated that Americans drink 13.15 billion gallons of carbonated drinks every year.
Since there has been such a rise in obesity at an early age, there have been many studies conducted that look at the consequences of consuming soft drinks on a daily basis. Some studies have shown that soft drinks contain large quantities of phosphorus, which when excreted pulls calcium out of the bones. Heavy users of soft drinks could experience osteoporosis along with damaged arteries over time.
In a recent study published this month by the American Journal of Clinical Nutrition, researchers tested the effects of consuming 1L of sucrose-sweetened beverages (regular soft drinks) over a 6 month time period. They also tested skim-milk, diet soda as well as water to compare the results. To date this has been the longest (time period) studied looking at the effects of these beverages. In this study, it was found that drinking regular soda may increase your blood pressure by 10-15 %, whereas the consumption of skim-milk and diet soda lowered blood pressure 5-7%. Researchers showed that the daily intake of regular cola increases fat accumulation and concentrations of triglycerides and total cholesterol whereas no differences in the relative change in fat accumulation were found between milk, diet cola and water groups. Total fat mass from the participants who drank regular soda increased 1.25kg over 6 months. Abdominal fat also increased in the regular soda and milk drinkers.
The most negative health effects of sucrose- sweetened beverages have been linked to the content of fast-absorbable fructose. Fructose may directly enhance lipogenesis (the process by which a metabolic molecule, Acetyl-CoA, is turned into fat), triglyceride production, and fat accumulation in the liver as well as increase circulating triglycerides and cholesterol concentrations. Ultimately, the intake of regular cola results in enhanced fat accumulation in the muscle and visceral adipose (fat) tissues. Consumption of regular soda may also play a role in increased prevalence of nonalcoholic fatty liver diseases.
One study shows that one extra soft drink a day gave a child a 60 percent greater chance of becoming obese. One could even link specific amounts of soda to specific amounts of weight gain. Each daily drink added 0.18 points to a child’s body mass index (BMI). It has been shown after measuring appetite-regulating hormones, that milk induces more of a “Full” feel than regular soda. To improve the health of the population, the intake of regular soda should be reduced and alternatives such as water or milk would be a healthier choice.
Adams, M. (2005). The health effects of drinking soda – quotes from the experts . Retrieved 1 13, 2012, from Natural News: http://www.naturalnews.com/004416.html
Maersk, M. (2012). Sucrose-Sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-month randomized interventional study. American Journal of Clinical Nutrition , 283-289.
Campbell, K., N. Andrianopoulos, et al. (2010). “Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study.” Appetite 55(1): 84-88.
About the Pulse of UTMC
A journal about how the people at UT Medical Center are improving the human condition. UTMC provides compassionate, university-caliber patient care while supporting and enhancing the health education of The University of Toledo.
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