Making Healthy Choices™

Don Hall DrPH, CHES
Founder of Wellsource, Inc.

• Primary Prevention of High Blood Pressure

• Quitting Smoking Adds Years to Your Life at Any Age

• Removing Disparities in Health and Longevity

• Nutrition and Prostate Cancer Prevention

• Selenium and Vitamin E Reduce Bladder Cancer Risk

• Nut Consumption and Risk of Type 2 Diabetes

• High Protein Diet and Weight Loss

• Excess Weight and Breast Cancer Risk

• WHO Identifies World's Leading Health Hazards

• New Coronary Risk Indicator, C-Reactive Protein

• Diet Trial and Reduction in Heart Attacks

• New Benefits of Exercise on Cardiovascular Health

• Effect of the Amount/Intensity of Exercise on Blood Lipids

• Enhanced Fitness has Anti-inflammatory Effects

• What's New? Diabetes Risk Profile

• About this Newsletter

Primary Prevention of High Blood Pressure

In spite of continued emphasis on blood pressure control, high blood pressure continues to be a major health problem. Consider the American Heart Associations statistics to the left. Preventing high blood pressure can reduce the risk for:

• Heart attack and heart failure

• Stroke

• Kidney disease

• Blindness

In America, blood pressure increases with increasing age. In populations that are healthier (active, not overweight, healthy eating habits, etc.) blood pressure does not increase with age. The most effective way to control high blood pressure problems is to prevent it from developing.

October 16, 2002 the National High Blood Pressure Education Program (NHBEP) of NIH launched a new program for the nation on prevention of high blood pressure.

Here are the new standards for blood pressure¹.

The NHBEP is recommending six major lifestyle modifications for the nation. These six modificationsare proven effective in reducing blood pressure¹. These same principles can help prevent a blood pressure problem from ever occurring.

1. Maintain a healthy weight. Body mass index (BMI) less than 25 and waist girth less than 35 inches for men or less than 33 inches for women is ideal.

2. Reduce dietary sodium intake to no more than 2400 mg per day (100 mmoles). That means cutting salt intake and salty foods (pickles, chips, soy sauce etc.) Also learn to read food labels.

3. Engage in regular aerobic physical activity such as brisk walking. Aim for at least 30 minutes per day, daily when possible. The national Institute of Medicine recommends working up to 60 minutes per day for optimum benefit.

4. Limit alcohol intake if you drink alcohol at all. A high alcohol intake (more than 1 drink per day for women or 2 per day for men) increases the risk of high blood pressure.

5. Maintain an adequate intake of dietary potassium. 3500 mg/day is recommended (90 mmol/day). Potassium is protective against high blood pressure. Most fruits and vegetables are good sources of potassium.

6. Consume a diet that is rich in fruits and vegetables. Also choose non or low fat dairy products and limit other foods high in saturated fat such as meats and rich desserts. This eating plan is called the DASH diet.

These 6 simple steps can significantly reduce the risk for high blood pressure. The good news is that even a small drop in pressure can result in a rather large drop in risk. For example, only a 5% drop in systolic blood pressure (top number) will:

• Reduce the risk of a stroke by 14%

• Reduce the risk of coronary heart disease by 9%

• Reduce the risk of mortality from any cause by 7%

Lifestyle Intervention Trial². A large community based intervention trial looked at weight loss and sodium reduction in reducing blood pressure. Everyone in the study had high blood pressure and were taking blood pressure medication. The study continued for 18 months.

Of those people who reduced their weight by only 10 pounds 36% were able to control their blood pressure without medication. 31% of those who reduced their sodium intake were able to get off their medications. If they both lost weight and reduced sodium intake, 53% were able to control their blood pressure without medications. These are remarkable results with only 2 of the 6 lifestyle changes being implemented. Think of the financial impact alone if half of all people on blood pressure medications could get off their medicines and control their pressure with healthy lifestyle changes!

References
1. Whelton PK et al, Primary prevention of hypertension, JAMA Oct. 16, 2002|
2. Whelton PK et al, Sodium reduction and weight loss in the treatment of Hypertension in older persons, JAMA Mar 18, 1998; 279:839-46

The greatest benefit, however, is quitting at a younger age. For example, men who quit at age 35 can expect to add 6.9 to 8.5 years to their life, and women can add between 6.1 and 7.7 years. It's a sobering thought that when people choose to continue smoking they are exchanging 6-8 years of their life for their cigarettes!

Quitting is difficult but there is help available from your doctor that can make it much easier and more likely that you can quit. Encourage people to ask their doctors for help.

CA Cancer Journal for Clinicians; 52:319, Nov/Dec 2002

Removing Disparities in Health and Longevity

Persons with a better education live significantly longer than those who have not finished high school. The University of California made a study of the primary causes of disparity in longevity, looking at education, race, and which health problems contributed the most towards early mortality. Here is what they found.

Education level. When adjusted for age, sex, and race, the number of potential life-years lost from all causes of death was 3.5 times greater for persons with less education than for persons with more education. In terms of actual years it was a difference of 9.2 years of life lost before age 75.

The primary diseases linked to less education were: heart disease, lung cancer, stroke, and lung disease.

When adjusted for age, sex, and education level, the number of potential life-years lost from all causes of death for African Americans was 35% greater compared to white persons, or a difference of 1.8 years. It's interesting that the major cause of disparity in life expectancy is not race, per say, but differences in level of education. To reduce health disparities you also need to reduce education disparities.

The primary causes of death linked to race were: high blood pressure, HIV, diabetes, and homicide. Based on this information, the authors made these conclusions:

• Given limited resources, the best strategy for eliminating health disparities for those with less education would by targeting heart disease and lung disease. Smoking would be an obvious key factor

• The best strategy for reducing health disparities among African-Americans would be to target high blood pressure, HIV, trauma, and diabetes.

Wong MD, et al. Contribution of major diseases to disparities in mortality, New England Journal of Medicine, Nov. 14, 2002; 347:1585-92

Nutrition and Prostate Cancer Prevention

Nutritional data continues to accumulate on the protective affect of good nutrition in preventing certain cancers. I'll review three recent studies dealing with prostate cancer, one of the most common cancers for men.

Several studies have hinted that lycopene, found in tomatoes, may protect against prostate cancer. Not all studies, however, were conclusive. New data from the large Health Professionals Follow-up Study confirms the earlier finding. This study included 47,365 men followed for six years. During this time 2,481 men got prostate cancer.

When the diets of these men were analyzed, frequent intake of tomatoes or lycopene was associated with a lower risk of prostate cancer (16% fewer cases of cancer). When researchers looked specifically at the intake of tomato sauce, they saw an even further reduced risk. There were 23% fewer cases of prostate cancer in those who ate tomato sauce at least twice per week versus those who seldom ate tomato sauce (lycopene is absorbed much more readily in tomato sauce than in fresh tomatoes).

Author's conclusion. "Frequent consumption of tomato products is associated with a lower risk of prostate cancer." This study provides strong evidence of the value of nutrition in preventing prostate cancer. It's quite remarkable to think that if all men ate tomato sauce and other tomato products at least twice per week that nearly 1/4th of all prostate cancers might be prevented!

King County Study. Another study on diet and prostate cancer in men looked at the intake of vegetables and cancer risk. They found that men who ate at least 4 servings of vegetables daily had a 35% decreased risk of prostate cancer compared to men eating less than 2 servings daily.

When they looked specifically at cruciferous vegetables (cabbage family), those men who ate 3 or more servings of cabbage family vegetables per week had a 41% decreased risk compared to those eating less than 1 serving per week.

China Study³. The most recent study on nutrition and prostate cancer was done in China, and is reported in this month's Journal of the National Cancer Institute. Researchers looked at the intake of onion family foods, specifically onions, garlic, and scallions (green onions). They compared men who ate the most of these foods (top one-third) with those who ate the least (bottom one-third). Here is what they found.

• Those who ate the most onions had a 49% decreased risk of prostate cancer

• Men eating the most garlic had a 53% decreased risk

• Men eating the most scallions had a 70% decreased risk

Summary: Here are three nutritional studies that show how you can significantly reduce your risk of prostate cancer. You might be able to cut your risk by half or more and it's not that hard to do:

1. Eat more tomato products, especially tomato sauce. A little olive oil in the sauce actually helps lycopene absorption.
2. Eat more vegetables, especially cabbage family vegetables (broccoli, cabbage, cauliflower, Brussels sprouts etc.)
3. Eat more onions, garlic, and scallions (green onions).

References
1. Giovannucci Edward, et al, A prospective study of tomato products, lycopene, and prostate cancer, Journal of the National Cancer Institute; 94:391-398, March 6, 2002
2. Cohen JH et al, Fruit and vegetable intakes and prostate cancer risk, Journal of the National Cancer Institute; 92:61-68, Jan. 5, 2000
3. Hsing AW, et al, Allium vegetables and risk of prostate cancer, Journal of the National Cancer Institute; 94:1648-1651, Nov 6, 2002

Selenium and Vitamin E Reduce Bladder Cancer
Selenium has been found to protect against cancer risk in several studies. In the November issue of Cancer Epidemiology, Biomarkers and Prevention, a new 6 year study of some 3000 men and women shows that selenium may protect against bladder cancer, especially in former smokers¹. Some 50,000 Americans are diagnosed with bladder cancer every year.

Should you look for selenium supplements? The researchers say no. Food sources are safer and more effective. To get adequate selenium, they recommend a balanced diet that includes lots of vegetables, nuts, whole-grains, and legumes. Brazil nuts are especially rich in selenium , so much so that only 1-2 nuts per day will give you all you need.

In the large Cancer Prevention II Study of nearly a million people, researchers found that people who took vitamin E for 10 or more years saw a 40% reduction in risk of bladder cancer². Vitamin C supplements showed no benefit.

1. Cancer Epidemiology, Biomarkers and Prevention, Nov 2002
2. Jacobs EJ et al, Vitamin C and vitamin E supplement use and bladder cancer mortality, American Journal of Epidemiology, Dec. 1, 2002; 156:1002-10

Nut Consumption and Risk of Type 2 Diabetes

The health benefits of nuts continue to appear in health journals. The latest study appears in the Nov. 27 issue of JAMA, and shows the relationship of nut consumption to the prevention of diabetes among nurses in the Nurses' Health Study¹.

Women who ate the most nuts (5 or more 1 oz servings per week) cut their risk of getting diabetes by 29%. Those women who ate nuts 5 or more times weekly and ate at least 2 servings of whole grains daily, cut their risk of getting diabetes by 57%.

Several studies have shown the protective affect of nuts for the cardiovascular system but this is the first study showing that nuts also protect against diabetes!

The researchers also looked at peanut butter separate from other nuts. Those women who ate peanut butter at least 5 or more times per week (serving size 1T) had a 21% reduction in diabetes.

Researchers pointed out some of the reasons why nuts may reduce the risk of diabetes.

• Nuts are rich in unsaturated fats and low in saturated or trans fatty acids. Trans fats have been shown to increase the risk of diabetes. Saturated fat has been shown to increase insulin resistance.

• Nuts are rich in fiber and magnesium, both of which are protective against diabetes.

• Nuts have a low glycemic index, thus they place a low demand on the pancreas for insulin.

• Nuts are a good source of vitamins, minerals, antioxidants, and plant proteins that may also be protective.

Weight gain concerns. Many people don't eat nuts because they are high in fat and they think fat will make them fat. The researchers looked at this issue and found that there was no difference in weight gain among those who were frequent nut eaters and those who seldom ate nuts. In fact, those who ate the most nuts had BMI values (a weight index) less than those who didn't eat nuts. The authors suggested that people needing to watch their calories eat nuts in place of refined grain products and red or processed meats to prevent an increase in calories eaten.

In summary. One easy way to reduce your risk of diabetes is to eat nuts and nut butters regularly, daily if possible. Use peanut butter as a spread in place of margarine. Along with the peanut butter, include at least 2-3 servings of whole grains daily. These simple additions to your meals can be pleasant (certainly not very difficult) and may cut your risk of diabetes in half.

1. Rui Jiang et al, Nut and peanut butter consumption and risk of type 2 diabetes in women, JAMA 288:2554-60, Nov 27, 2002

High-Protein, Low Carbohydrate Diets
>A small study presented at the recent annual American Heart Association meeting sponsored by the Atkins Foundation has created enormous media comment. The study showed that on a high protein-low carbohydrate diet people lost more weight than on a low-fat "AHA Diet", and they did not raise their cholesterol levels. To help set the record straight, the American Heart Association (AHA) has issued a formal response. Here are the AHA's concerns:

• The study is very small (60 people on the diet)

• It was a short term study (only 6 months)

• There is no evidence that the diet is effective long term

• The high intake of saturated fats over time raises great concern about cardiovascular risk -- the study did not follow participants long enough to evaluate this aspect

• The study did not actually compare the Atkins diet with the current AHA dietary recommendations

• People who want to lose weight and keep it off need to make lifestyle changes for the long term -- this means regular exercise and a healthy diet you can maintain for a lifetime

In contrast to this small study, the AHA is emphasizing a 12 year Harvard study, also reported at this meeting but with little or no media coverage. This study included 74,000 people and showed that those who consumed more fruits and vegetables were 26% less likely to become obese than those who ate few fruits and vegetables (as advocated in the Atkins diet). The AHA stresses that this is a much more compelling study regarding weight control because it involved a large population for many years.

American Heart Association News release, Nov. 19, 2002

Excess Weight and Breast Cancer Risk

Excess body weight appears to be more important in cancer risk than previously thought. Data from the very large Cancer Prevention II Study¹ (424,168 postmenopausal women) found a very substantial increase in risk of breast cancer with increasing body mass index (BMI, a measure of obesity).

From the data in this study, researchers estimate that approximately 30-50% of breast cancer deaths among postmenopausal women is attributable to overweight. Their conclusion states, "Postmenopausal obesity is an important and potentially avoidable predictor of fatal breast cancer in this study." These results emphasize the importance of maintaining moderate weight throughout one's life.

1. Petrelli JM et al, Body mass index, height, and postmenopausal breast cancer mortality, Cancer Causes and Control 13:325-32, May 2002

WHO Identifies World's Leading Health Hazards

What risk factors contribute most to the burden of disease in the world? This is the task a recent World Health Organization (WHO) research team began investigating. Causes vary, of course, depending on the degree of development of the country. Here is a brief report of what the WHO committee found.

In most developed countries, here are the leading health hazards in terms of Disability Adjusted Life Years (DALY) in decreasing order of importance:

• Tobacco use

• High blood pressure

• Alcohol

• High cholesterol

• Overweight

• A low intake of fruits and vegetables

• Physical inactivity

• Illicit drug use

• Unsafe sex

This list differs significantly from health hazards in the least developed countries:

• Underweight (malnourished, inadequate food)

• Unsafe sex

• Unsafe water, sanitation, and hygiene

• Indoor smoke from solid fuels

• Zinc deficiency

• Iron deficiency

• Vitamin A deficiency

• High blood pressure

• Tobacco use

• High cholesterol

To improve the health of a nation in the context of limited resources, you need a strategy that emphasizes prevention to reduce the burden of disease rather than just treating disease (such as AIDS or lung cancer). The WHO report states that the treatment of disease will always have a place, but a greater emphasis and commitment in funding prevention could greatly reduce the loss of healthy life in most nations.

1. Ludwig DS et al, Relation between consumption of sugar-sweetened drinks and childhood obesity, The Lancet Feb 17, 2001; 367:505-08

New Coronary Risk Indicator, C-Reactive Protein

Part of the underlying cause of coronary artery disease is an inflammatory process that damages the artery wall, hastening build-up of fatty plaque in the arteries. This tendency for inflammation in the body can be measured with a blood test called "C-Reactive Protein" or CRP.

How important this process of inflammation is in causing heart disease is shown by a new study of 27,939 healthy women who were checked for both LDL cholesterol levels and C-reactive protein then followed for 8 years to see who would get cardiovascular disease (heart attack, stroke, angioplasty, or death from cardiovascular disease)¹.

Women with high CRP levels at the start of the study were 2.3 times more likely to develop a cardiovascular problem than those with low values. In fact, CRP was a better predictor of future cardiovascular events than LDL cholesterol (see chart on right).

The researchers point out that nearly half of all cardiovascular events that occurred during the 8 year study were to women with LDL cholesterol levels in the "desirable range (less than 130 mg/dL). This points out the need to measure multiple risk factors, including CRP levels, to determine those at highest overall risk. Even when women had low LDL cholesterol levels, if their CRP levels were high, they had a high risk of a future cardiovascular event. The research authors conclude, "C-reactive protein, a marker of systemic inflammation, is a stronger predictor of future cardiovascular events than even LDL cholesterol."

Persons with the lowest risk for future heart problems or stroke have a "High sensitivity C-Reactive Protein" level of 0.5 mg/L or lower. Average CRP levels for this group of women aged 45-74 was 1.52 mg/liter.

What causes this inflammation process in the body? Excess abdominal body fat is a major cause. Studies show that as people eat more healthfully, get regular exercise, and lose weight, their CRP blood tests drop dramatically. In the Cardiovascular Health Study² that included 5,888 men and women, those who were most active had lower levels of inflammation.

Other studies show that aspirin may lower inflammation and CRP levels, and statin medications for lowering cholesterol also lower CRP levels. Further research is need in this new area to know how best to deal with this newest risk indicator. In the mean time, eat heart healthy meals, lose excess body fat (even 10-15 pounds helps greatly), and get regular physical activity.

1. Ridker PM, et al. Camparison of C-reactive protein and LDL cholesterol levels in the prediction of first cardiovascular events, New England Journal of Medicine Nov. 14, 2002; 347:1557-65
2. Geffken D et al. Association between physical activity and markers of inflammation in a healthy elderly population. American Journal of Epidemiology 2001; 153:242-50

Diet Trial and Reduction in Heart Attacks

Dietary trials using whole foods seem to be most effective in reducing heart risk. The Lyon Heart study¹ diet using the Mediterranean diet (high in fruits, vegetables, nuts, fish, olive oil, and omega-3 fatty acid rich margarine) saw nearly a 70% reduction in coronary events and deaths from heart attacks even without any significant change in blood cholesterol levels.

A new dietary trial, the Indo-Mediterranean Diet Heart Study², is reporting similar positive results using a similar diet but also emphasizing whole grains. The study included 1000 patients in India with heart problems. Half followed an experimental diet rich in whole grains, fruits, vegetables, nuts (particularly walnuts and almonds), and vegetable oils high in n-3 fatty acids (alpha-linolenic acid). The other half ate a control or local diet similar to the NCEP step 1 diet (low in total fat and cholesterol). Both groups were also encouraged to walk 2 miles daily.

After two years here is what they found. The n-3 fatty acid intake in the experimental group was more than twice that of the control group. The intervention group had a significant reduction (53%) in cardiac events and sudden cardiac death compared with the controls, even after controlling for BMI, cholesterol, and blood pressure. Both groups got similar amounts of exercise and 2/3 of both groups were vegetarians. In this study, researchers stressed a high intake of alpha-linolenic acid as the primary source of n-3 fatty acids in place of fish (as used in the Mediterranean diet) as most Indians prefer a meat-free diet.

The authors summarized by saying, "Over 2 years, a diet enriched with fruits, vegetables, legumes, nuts, whole grains, and soybean oil is associated with a pronounced decline in coronary artery disease morbidity and mortality." They also pointed out that this form of treatment is inexpensive and realistic for countries with many poor people such as India. The food for a whole day cost about $1.00 for each participant. This is far cheaper than cholesterol lowering medications, and the results were better in reducing coronary risk than in most medication studies.

This study illustrates two important concepts.

• A healthy lifestyle approach is a very practical and effective approach for preventing heart disease even in people with existing heart problems.

• A diet high in alpha-linolenic acid (an n-3 fatty acid) is very protective against heart disease and can have protective effects in addition to lowering cholesterol levels. The same can be said for whole-grains, fruits, vegetables, and nuts.

1. de Lorgeril MS, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications -- Final report of the Lyon Diet Heart Study, Circulation 1999; 99:779-85
2. Singh RB, et al. Effect of an Indo-Mediterranean diet on progression of coronary artery disease, The Lancet Nov 9, 2002; 360:1455-61

New Benefits of Exercise on Cardiovascular Health

Research continues to show new benefits of exercise on the heart and circulation. We've known for some time that regular exercise strengthens the heart and reduces the risk of heart attack. This is especially important for people with high blood pressure and diabetes, both of which damage the circulatory system.

Left ventricle dysfunction. A common heart problem in diabetics is reduced function of the left ventricle which pumps blood to the whole body. The ventricle becomes stiff and thus slows filling with blood. It also becomes weak and loses contractility. Exercise improves artery compliance (arteries become less stiff so they function better) and strengthens contractility of the left ventricle (improving its ability to pump more blood with each stroke).

Endothelial function. A big problem with diabetes and high blood pressure is endothelial dysfunction. The endothelium is the lining of the artery. It controls vital functions such as the ability of the artery to dilate when more blood is needed, the inflammatory response, and clotting mechanisms. Both high blood pressure and diabetes decrease endothelial function. Exercise improves both. In just 12 weeks in a group of pre-diabetics, exercise training showed significant improvement in endothelial function.

Stiff arteries. With aging and when hastened by high blood pressure and diabetes, the arteries become more stiff. Stiff arteries don't open up as well to let the blood flow through, thus contributing further to high blood pressure and poor circulation. In the Baltimore Longitudinal Study on aging, those who exercised regularly had less arterial stiffness. Other studies of older men with a lifetime of regular, strenuous exercise also showed less stiffness. By exercising, you cause the arteries to enlarge and contract as needed to meet blood flow demands. This exercise of the arteries helps prevent stiffness and improves circulation.

Exercise and inflammation. It's recognized now that inflammation is a major factor in initiating and hastening the accumulation of cholesterol plaques in the arteries. Inflammation is much more common in people who are overweight, sedentary, and have diabetes. People who exercise regularly have lower levels of inflammation. One study showed that after 6 months in a walking program, patients showed significant reductions in markers for inflammation.

Body composition. Obesity, especially excess abdominal fat, is strongly related to both high blood pressure and diabetes. In a recent randomized trial, patients with diabetes performed aerobic exercise 3 times a week for 2 months. They showed no loss in weight on the scales but had a 48% decrease in abdominal fat. They also had significant improvement in insulin sensitivity.

The bottom line is this. If you want healthy arteries and a good circulation, get regular exercise. This is even more important for people with high blood pressure, obesity, and diabetes. Get your doctor's clearance, then aim for 30 minutes (and eventually as much as 60 minutes if needed) of daily activity such as brisk walking, cycling, or other moderate activities. Your heart and arteries will thank you!

Stewart KJ. Exercise training and the cardiovascular consequences of type 2 diabetes and hypertension, JAMA Oct. 2, 2002; 288:1622-31

Effect of Intensity of Exercise on Blood Lipids

Increased physical activity is clearly linked to decreased risk of heart problems. The question that still remains is how much exercise do you need for optimal benefits, and how vigorous does the activity need to be?

Duke University studied this question by putting people on three different exercise regimes to see which would be the most effective.
1. Moderate intensity, equivalent of walking 12 miles per week
2. High intensity, equivalent of running 12 miles per week
3. High intensity, equivalent to running 20 miles per week

Each group exercised for 8 months. Weight was held constant to eliminate weight loss as a factor in lipid changes.

In those exercising at the 12 miles per week level, both the walkers and runners saw improvement in blood lipids (lower triglyceride levels and other positive changes in LDL cholesterol). The improvements were related more to the amount of activity, however, than to the intensity.

Joggers who competed 20 aerobic miles weekly at a moderate pace had the most improvement, especially in HDL cholesterol levels. After 8 months of training, their HDL levels rose about 10%. Other research shows that for every 1% your HDL levels increase, your risk of heart disease drops by 2-3%. That would be a drop in coronary risk of 20-30%.

Those who exercised at the 12 miles per week level had many improvements, but neither group had a significant increase in HDL cholesterol. It appears that you need more exercise to see improvements in HDL, at least 15-20 aerobic miles per week for significant improvement. Those who got the most exercise had the greatest improvement overall in lipid changes important to heart health.

These findings are consistent with the recommendations from the Institute of Medicine (IOM). The IOM increased the recommended amount of moderate exercise from 30 to 60 minutes daily when possible. An hour's walk 4-5 times per week would be equivalent to 16-20 miles per week. Jogging for 30-35 minutes, 5 times per week would be equivalent to 15 to 20 aerobic miles per week. While any exercise is beneficial, it appears that 15-20 aerobic miles per week may be optimum for best health.

This study is also good news for those who find it easier to exercise daily than to lose weight. Activity can improve blood lipid results even without weight loss.

Kraus WE, et al. Effects of the amount and intensity of exercise on plasma lipoproteins, New England Journal of Medicine Nov 7, 2002; 347:1483-92

Enhanced Fitness Has Anti-inflammatory Effects

The benefits of a high fitness level are well established, but new benefits continue to emerge. The latest benefit is that regular exercise helps reduce systemic inflammation as measured by C-reactive protein. C-reactive protein (CRP) is now considered an important risk factor for coronary heart disease. A high CRP level increases the risk for coronary heart disease.

The Cooper Institute in Dallas Texas measured the C-reactive protein levels of 722 men and also tested their fitness levels on a treadmill. They found that fit men had lower levels of C-reactive protein (CRP), a marker for inflammation. Those men who were least fit (bottom 20%) had an average CRP level of 1.64 mg/L. Those who were most fit (top 20%) had the lowest levels of CRP (0.70 mg/dL), a 57% decrease¹.

Those men who were most fit were 83% less likely to have a high CRP level than those men who were least fit. The relationship between CRP levels and fitness remains even after adjusting for obesity and waist girth. This study helps explain why fit people are less likely to have heart disease.

A study on women showed similar results. Fit women had lower CRP levels than unfit women².

Bottom line. Regular exercise along with losing excess weight and stopping smoking are good ways to reduce inflammation in the body and to prevent early heart disease.

1. Church TS, et al. Associations between cardiorespiratory fitness and C-reactive protein in men, Arteriosclerosis Thrombosis and Vascular Biology, Nov 1, 2002; 22:1869-76
2. LaMonte MJ, et al. Cardiorespiratory fitness and C-reactive protein among a tri-ethnic sample of women, Circulation Jul 23, 2002; 106:403-6

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Diabetes Risk Profile is our latest disease management assessment for the desktop computer. This program is used to:

1. Screen your "Well" population to find people at high risk for diabetes and follow-up with a prevention report.
2. Identify people with diabetes and how best to manage their health needs to prevent complications. Includes a diabetes care plan that can be customized by the health professional.

• Identify diabetics from your "Well" population

• Track diabetics progress

• Remind diabetics and high risk groups to schedule regular checkups

• Follow-up educational and intervention programs in print format and on the web

The Diabetes Risk Profile is an essential part of any disease management program.

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The seminar provides professionals in the health care industry with the opportunity to network with peers and share successes and challenges. The learning experience is facilitated with interactive workshops that encourage participation. For program schedule and registration form. Register early to receive discounted registration and hotel rates.

For further information on the Diabetes Risk Profile or our Wellness Seminars, visit our website www.wellsource.com, call a Director of Business Development at 1-800-533-9355, or e-mail marketing@wellsource.com.

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About Making Healthy Choices

Making Healthy Choices is written by Don Hall, DrPH, CHES president of Wellsource Inc. with contribution from associated health professionals. It is available as a resource to Wellsource clients and other select organizations involved in promoting health.

Content is general health information from evidence based research. Its purpose is not to treat disease but to promote healthy lifestyles. Persons with health problems should consult their physician for specific guidance.

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