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Obesity and Subclinical Heart Disease
When a patient meets certain set criteria for a disease or condition, we doctors say that they have clinical [disease or condition]. For example, the World Health Organization and the National Institute of Health have designated a Body Mass Index of 30 or more as clinically obese. On the other hand, with some conditions a patient might have the condition, yet not show symptoms, and that is called subclinical [condition].
Mediterranean Diet and Heart Disease: Current Research
Here at Dr. Gourmet we've written a lot about the Mediterranean Diet and how it not only can help you live longer; protect you from heart disease, high blood pressure, stroke and other heart problems; and is also the best diet for those with type 2 diabetes. What is called the Mediterranean Diet is not what you'd think of as a diet per se....
Finding a direct link from sodium to heart disease
I like to tell my medical students that "medicine is not math." Remember that Transitive Property of Equality you might have learned about in Algebra? Where if A = B and B = C, then A always equals C? Medicine is not like that. (Would that it were!) In medicine, sometimes A = B and B = C, but A has no relation to or effect on C.
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Remember when David Letterman had his heart trouble a few years ago? He talked about how his doctors had told him that he couldn't drink coffee anymore, and all I could think was, "Find a new doctor."
There was never good evidence for telling patients not to drink coffee after a heart attack. In fact, there's a ton of research showing that coffee is NOT bad for you, and if anything may actually be good for your health. The latest issue of Circulation, from the American Heart Association (Circulation 2007;116:2944-2951) has a great article specifically about coffee intake after a heart attack.
Researchers in Italy enrolled over 11,000 recent heart attack sufferers in a study lasting 3 and a half years. At the beginning of the study and at regular intervals throughout, the subjects were interviewed regarding their diet, including specifically their coffee intake. The diet and coffee intake of those subjects who experienced another heart attack or a stroke during the study were compared with those subjects who did not.
Interestingly, those who drank less coffee tended to have generally better dietary habits, while those who drank a lot of coffee tended to weigh more and smoke. When looking just at coffee consumption, however, those who drank more than 4 cups of coffee per day had a reduced risk of stroke or heart attack of 46%!
After controlling for the subjects' age and gender, on the other hand, the association between coffee drinking and heart attack or stroke disappeared. No greater risk, and no reduction in risk. Further analyses, controlling for various factors such as smoking, diabetes, and obesity, had the same results: again, no increase OR reduction in risk. It appeared that coffee drinking made no difference.
So go ahead and drink your coffee (or espresso or mocha, as most of the subjects in this study did). Don't disregard your doctor's orders, but you might ask them if they've seen this study. I do love that the Italians did this study. They really know what is important in life!
First posted: December 5, 2007