There is more than one source of white in Christmas

By Dr. Franco


This year I was closer than ever before to a white Christmas, and in places like Belgium a white Christmas occurred for the first time after 23 years. However, In Leiden (the Netherlands) where we gathered this year with friends and family to celebrate Christmas, no snow fell on the 25th, and from the snow accumulated the previous days there was only just enough to throw a few last snowballs.

But besides celebrating, sharing and being able to express our artistic skills with anthropomorphic sculptures in the snow, this season is also marked by excesses of food and drink. Almost every evening in the last week I have been able to enjoy the fruits of culinary feasts that make of this season the kindest to our senses but one of the riskiest to our health. Behind the alcohol, pudding, turkey and fatty products that should be consumed in moderation, hides a darker source of white to this season: salt.

Salt is perhaps one of the finest and tastiest gifts that nature has provided us with. The spice of life surely, salt has been one of the greatest assets to humankind, but is also one of its greatest threats generally considered a silent killer. Salt increases our blood pressure, and the greater the amount of salt intake the higher the level of blood pressure, and the higher the risk of suffering a stroke and heart disease.

In a recent manuscript published in the British Medical Journal, a team of scientists from the University of Naples in Italy and the University of Warwick in the UK aimed to compile all the evidence available on the effect that high levels of salt consumption might have on the risk of suffering stroke or heart disease. They found that reducing the daily consumption of salt by approximately 5 grams (1 teaspoon of salt) could provide a 23% reduction in the risk of stroke and a 17% reduction in the risk of heart disease. Such a measure could avert about one and a quarter million deaths from stroke and almost three million deaths from heart disease each year!

But how can we reduce our salt intake? Here are some tips that you might want to use when making your New Year’s resolution(s):
- Increase the consumption of foods rich in potassium: fruits and vegetables
- Eat/cook at home more, and when eating out ask the chef to reduce the amount of salt
- Cook low in salt and add only small amounts at the end
- Try to have less than 6 grams a day of salt (a teaspoon)
- Use fewer sauces, mixes and canned products.
- Aim to progressively reduce your salt intake. Everyday a bit less and your palate wont notice it.



Reference:
Strazzullo P, D'Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ. 2009 Nov 24;339:b4567.

Global warming and winter wonderland: contradiction and paradox?

By Dr. Franco

Are you dreaming of a white Christmas? This will be my ninth Christmas in Europe and for the first time I am approaching it in top of white blanket of snow and with a very high probability of experiencing my first ever white Christmas. The evergreen island of Britain is now immaculately white. Does this mean that global warming is nothing but a staged theoretical situation forged by bored scientists with nothing better to do in their spare time?

I was surprised yesterday when I picked a local newspaper and found the following headline on its front page: “Global warming? Snowballs!!” (Referring to the current winter wonderland that we are experiencing in the UK). However, these two situations are not contradictory. On the contrary, extreme weather conditions like the current storm being experienced in the east of USA are a consequence of climate change. And if we don’t take action to mitigate climate change and heal our planet these extreme weather situations will become more frequent and even more intense.

But what can we do? In a scientific paper recently published in the Lancet, we aimed to evaluate the potential public health impact of transportation strategies aimed to reduce greenhouse emissions. Considering that transport accounts for a large part of all greenhouse-gas emissions (almost a quarter of all fossil fuel greenhouse emissions), we found that reducing motor vehicle use through more walking and cycling will not only help to mitigate climate change but should also substantially contribute to reducing obesity, heart disease and improving our trajectories of ageing.

Using greener transport alternatives and reducing greenhouse-gas emissions should not be the sole responsibility of governments and policy makers and all of us -citizens of planet earth- should be hold accountable for our decisions and their consequences. So lets think twice before we take the car and lets try to choose the bike or just walk instead of driving comfortably, but poisonously. This would not only help to mitigate current climate change but will also help us to keep fit, avoid heart disease and enjoy the most of this and many more white Christmases to come.

Finally as “tiny Tim” said: "A Merry Christmas to us all; God bless us, every one!"… and don’t forget to bless our planet!

Reference:Woodcock J, Edwards P, Tonne C, Armstrong BG, Ashiru O, Banister D, Beevers S, Chalabi Z, Chowdhury Z, Cohen A, Franco OH, Haines A, Hickman R, Lindsay G, Mittal I, Mohan D, Tiwari G, Woodward A, Roberts I. Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. Lancet. 2009 Dec 5;374(9705):1930-43.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61714-1/fulltext (you must register to access the full article for free).

All for one… and statins for all?

By Dr. Franco

Since the 70’s when statins were discovered by Japanese Drs. Endo and Koruda, these pharmacological compounds have attracted broad attention and have been widely investigated. Statins act by inhibiting an enzyme called HMG-CoA reductase, which is key in the production of cholesterol in the liver and therefore lower the blood levels of cholesterol. By these and other mechanisms (e.j. inflammation reduction, improvement in endothelial function) statins substantially contribute to decrease the risk of developing cardiovascular disease (namely myocardial infarction and stroke).

Different studies have demonstrated the ample benefits of administering statins to individuals suffering from heart disease. Whether to administer statins to those without heart disease nevertheless remains controversial. In a recent meta-analysis (a collection and summary of studies performed in a particular subject) published in the British Medical Journal (BMJ), researchers from Erasmus MC in Rotterdam, the Netherlands, aimed to evaluate the benefits of giving statins to people without cardiovascular disease but with different risk factors for this disorder. The results of this study provide a complex picture, showing that although taking statins reduced mortality as well as heart disease events, many people would have to be treated to prevent one event or death. Furthermore, potential adverse effects could occur among those taking statins, as the authors conclude: “Concerns might remain about the higher risk of cancer in elderly patients (70-82 years)… and further follow-up studies in such patients are required”

It appears from this comprehensive summary of the evidence that statins are a good alternative to reduce the risk of cardiovascular disease but that needs to prescribed to many in order to save a few and that could generate unnecessary adverse effects. Should those who do not suffer from heart disease use statins? That remains a partly unanswered question, but why not avoid the need of taking statins by following a healthy lifestyle? Adequate levels of physical activity, following a healthy diet, no smoking and good sleep patterns have all been related with potential reductions of heart disease risk. Its never too late and you could have fun and improve your quality of life while doing it.

Reference:
Brugts JJ, Yetgin T, Hoeks SE, Gotto AM, Shepherd J, Westendorp RG, de Craen AJ, Knopp RH, Nakamura H, Ridker P, van Domburg R, Deckers JW. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ. 2009 Jun 30;338:b2376

There is a ‘D’ in Healthy Aging

By Dr. Franco

There is nothing like the warm sensation of feeling the sun rays warming up your skin and filling your soul with joy and energy. I can still remember consciously experiencing this for the first time when I was three years old, my own ‘sun birth’. I was taking swimming lessons, after which I laid down for a couple of minutes enjoying the warmth of our star and left with the necessary energy for the soccer match that was to follow.

But taking the sun does not only feel good, it is also good for our health.
Adequate levels of sun exposure are fundamental to avoid low levels of vitamin D, which have been associated with increased risk of suffering from osteoporosis, diabetes, metabolic syndrome (a conglomerate of metabolic abnormalities that increases the risk of cardiovascular disease and mortality) and depressive symptoms.

In a recent study published in the scientific journal ‘Diabetes Care’ we evaluated the levels of vitamin D in a population of Chinese (aged 50+) and the impact of these on metabolic syndrome. We found alarming low levels of vitamin D with almost 70 percent of this population having vitamin D deficiency. We also found that low levels of vitamin D were associated with an increased risk of metabolic syndrome and insulin resistance (a step involved in the development of diabetes).
Analyses in other populations (including Americans) have found similarly low levels of vitamin D in the elderly and significant associations with metabolic syndrome highlighting the need for us all to seek adequate levels of sun exposure, normally recommended as no more than 30 minutes twice per week.

Just as I pleasantly remember my early sun encounters, however, I can still feel the exasperatingly unpleasant sensation in my skin secondary to abusive sun exposure. Moderation is key, and too much of anything -even if it’s good- is detrimental… and sun exposure is not the exception. Too much sun will not only give you the unpleasant feeling of an irritating sunburn but also an increased risk of skin cancer. But this should not make us afraid of the sun; just remember not to soak up too much heat. Enjoy the gifts that Mother Nature blessed us with, but remember, moderation is the key.

Reference:
Lu L, Yu Z, Pan A, Hu FB, Franco OH, Li H, Li X, Yang X, Chen Y, Lin X. Plasma 25-hydroxyvitamin D concentration and metabolic syndrome among middle-aged and elderly Chinese individuals. Diabetes Care. 2009 Jul;32(7):1278-83