The Tip of the Iceberg

Last week I was honored to present on the obesity-diabetes-and artery disease epidemic to a group of Delta employees in Atlanta. The venue was warm and inviting and very well organized. The participants were engaged and asked a large number of insightful questions. After my talk was over, I was invited to one of the working areas and I was happy to see that there were so many standing desks and a lot of opportunities for the employees to be physically active. A great workplace!

I used several PowerPoint slides for my presentation. One of those showed a picture of a gigantic iceberg where both the above-the-surface and below-the-surface parts of the iceberg were visible. The caption read: “Why am I showing you this picture?” After I let the question sink in the minds of the audience for a few seconds, I presented the next slide. There was the picture of a huge belly of a man. The face or the rest of the body were not shown; the focus was on the belly. The caption read: “Because it is so easy to see this…”. The next slide followed in quick succession and its caption picked up where the previous one left: “...but you can’t see that!” 

Just like the iceberg that sunk the Titanic, what is hiding below the surface is the most dangerous. Our artery health can’t be seen from the outside, but inside, the story is much different.

You can clearly see the “deeper issue” in this up-close photo of an adult artery.

The “that” was the inside of an artery of a person with a huge belly like the one on the slide. The artery looked ugly, like a war zone. Instead of appearing like a smooth glistening tube, the inside of the artery was uneven, filled with dirty-looking red and yellow growths, like tumors. These tumors were not cancers; they were advanced-stage cholesterol plaques with bleeding and clots on their surface. Such an artery can become the cause of a heart attack, stroke or sudden death without further notice. The slide that followed showed exactly how such a thing can happen. Most of us (especially men) start developing thin fatty lines in the wall of our arteries when we are teenagers. These early fat accumulations are called “fatty streaks” and represent the only form of cholesterol accumulation in our arteries that is reversible.  As the cholesterol plaques continue to develop, it usually takes them a minimum of 20 plus years to mature and, usually, cause zero symptoms during that phase. Once mature, they can, all of a sudden and without any further warning, become unstable, and within a minute they can be causing serious symptoms like chest pain, heart attack, stroke or even sudden death. 

Unfortunately, in western countries like ours, by the time we are 45 years of age most of us (especially men) do have some cholesterol plaque in the walls of our arteries. As long as these plaques stay stable, they are not a health problem and usually cause no symptoms. Once unstable, the result is catastrophic. So, what do we need to do to keep any plaques stable:

• No smoking (not even one or two cigarettes a day)

• Keeping our blood pressure and LDL cholesterol low (our health care provider will advise us whether or not we need medications to achieve this)

• Staying physically and socially active

• Eating a healthy diet with an emphasis on avoiding abdominal obesity by excluding fast carbs

• Avoiding alcohol abuse

• Sleeping at least 7 hours per night

• Avoiding excessive stress

So, take good care of your arteries in order to keep any possible cholesterol plaques at bay and enjoy a long life without heart attacks, strokes or the need for heart surgery or other heart procedures.

To your health,

Dr. Anthony

The Shocking 65 & Other "Sweet" Tales

Last week, while preparing for a presentation on wellness, I came along food labels for certain soft and energy drinks.

I must have read this type of information hundreds of times but it never stops shockingly amaze me to realize that they may contain up to 65 grams of sugar (or more) per 600 ml (20 oz)!

Now consider that the American Heart Association recommends no more than 25 grams of added sugar per day for women and no more than 37.5 gm of added sugars per day for men. So, if you just consumed 20 oz of a sugary beverage you’ve probably gulped in your added sugar allowance for an entire 2-day period!

And it is not just sugary beverages that contain a shocking amount of sugar, much more sugar that a health-conscious person could possibly afford. All of the so called “fast carbs” (high glycemic index carbohydrates) have lots of sugars that are quickly digested and absorbed from the stomach into the bloodstream. Fast carbs include not only sugary beverages, cookies, desserts, ice cream, baked goods and donuts but also added sugars found in low-fat yogurt and starches present in white bread, white pasta, white rice, white potatoes. If consumed daily or in large quantities, fast carbs are dangerous for our health because:

• They have a great taste and texture that we cannot resist

• Instead of keeping us full for several hours they promote hunger: the sugar-high leads to insulin-spike and then, 1.5-2 hours later, sugar-low, making us hungry and forcing us to eat again and again.

So, read the food labels and limit the amount of added sugar you have per day to no more than the equivalent of 6-9 teaspoons of table sugar. Avoid sugary beverages and be skeptical of “low-fat” yogurt. If you cannot entirely resist white bread, white pasta, white rice or white potatoes, consume them only in small amounts. If you are diabetic or obese, I highly recommend that you invest in a personal nutritionist. It will be one of the best investments you can make in your health journey!

To your health,

Dr. Anthony

OBESITY 1988-2014: There is good news and bad news…well, sort of good news.

The good news is according to the findings of the Journal of the American Heart Association, obese adults (those age 20 and over, with BMI above 30) are now at lower risk for developing heart disease, compared to 30 years ago. However, with the good comes the bad - and the bad news is obese individuals are MORE at risk of developing Type 2 Diabetes.  

So what does all this mean? Well, first we need to understand diabetes … According to the American Diabetes Association, in diabetes there is a problem with the body’s metabolism that causes sugar (glucose) to rise in the bloodstream whereas the cells, that need glucose as their energy source, are starving. How does this happen?

1. The main source of glucose is the carbs we eat; these carbs are digested and absorbed through the stomach and then enter into the bloodstream primarily as glucose (sugar).

2. Once glucose is in the bloodstream, it can reach all the cells in your body. Once these sugar molecules arrive at their destination, imagine them knocking on the cell’s door, the body orders the pancreas to produce insulin, the “key” that opens the cell’s door and lets the sugar in.

3. Either the pancreas cannot produce enough insulin (type 1 and late type 2 diabetes) or the normal amounts of insulin fail to work properly (“insulin resistance”/obesity and early type 2 diabetes).  Over time both these abnormalities take place and result in excess sugar in the bloodstream (with toxic effects for the cells) and, at the same time, severe shortage of sugar inside the cells.

4. The cells are then forced to turn into fat, instead of sugar, for their energy needs. This diabetic state is very damaging to the body - both through the toxic effects of high blood sugar levels which can cause blindness, kidney failure and nerve damage to widespread damage of our arteries, leading to heart attacks, stroke and leg amputations.

The Center for disease control states 29 million people in the United states have diabetes which is three million more than just six years ago.  Worldwide more than 380 million people suffer from diabetes.  More than one in three adults in the US have pre-diabetes which us 86 million people. A healthy lifestyle, including almost daily exercise and healthy diet, both reduces the chances of becoming diabetic in the first place and improves the outcome in those already suffering from diabetes.

Now is the time to take on the challenge of obesity and diabetes. Not only do we need to personally practice prevention, but we also need to convey the message of wellness, through our personal examples, skills and knowledge, to our loved ones, our colleagues and the society at large. There is no reason why we cannot succeed in the fight against obesity and diabetes, should we show the necessary resolve and determination, and be given the time required to re-engineer our daily lives, both in the workplace and at home. Spread the good news and work for what remains to be done. Take care of yourself and your loved ones and help prove wrong the pessimistic statistics on the future of obesity and diabetes.

To your health!  

Dr. Anthony