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Nwizu Chima C MD
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A Heart Healthy Approach to Reduce Risk of Heart Disease and Stroke:

The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) advocates the following Therapeutic Lifestyle Changes (TLC) to lower serum LDL-C (low density lipoprotein cholesterol) levels:
- Dietary cholesterol <200 mg per day
- Saturated fat <7% of total daily calories
- Increase soluble (viscous) fiber intake to 10 – 25 grams daily
- Consume at least 2 grams of plant stanols/sterols daily (not recommended for those with a condition called Sitosterolemia)
- Increased physical activity to at least 200 Kcal per day.

Macronutrient component of the therapeutic lifestyle changes (TLC) recommended by NCEP ATP III include:

Macronutrient Recommendation

Carbohydrate 50 - 60% of total daily calories
Protein 15% of total daily calories
Fat 25 – 35% of total daily calories
Monounsaturated fat up to 20% of total daily calories
Polyunsaturated fat up to 10% of total daily calories

These therapeutic lifestyle changes, especially when combined with exercise, weight loss and smoking cessation, have been shown in lipid (Cholesterol) trials to reduce LDL-C (the bad cholesterol) and consequently, reduce the risk of heart attack and stroke
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Did You Know That?
Aggressive long-term diet and exercise regime (as in the Look AHEAD Trial) can result in less need for insulin treatment, can reduce central adiposity (belly fat), A1C (improved glucose control), advanced kidney disease and many other heart attack (cardiovascular) and stroke risk factors but may not reduce heart attack or strokes.
The non-reduction in the heart and stroke events, even though they improve risk factors for heart attacks and strokes such as hypertension, diabetes, metabolic syndrome, insulin resistance, lipid (cholesterol) profile, is most likely because these risk factors would have been operating for decades, during which time they would have caused significant damage to the blood vessels. The longer an individual had had these risk factors, the more likelihood that sustained irreversible damage would have taken place within the individual’s arteries (blood vessels), that would ultimately lead to higher levels of sustained chances of heart attack or stroke.
However, when these risk factors have been present for shorter durations of time, some, if not all the damages to the arterial walls could be reversed by lifestyle changes such as weight loss, diet and exercise. The family of cholesterol lowering medications known as the ‘statins’ play a proven and significant role in the reversal, regression and/or stabilization of these changes in the blood vessels. They have been seen in numerous good quality medical research to confer significant protection to heart attack and stroke to individuals with these heart attack and stroke risk factors and with atherosclerosis (damage to blood vessels).
Exercising daily without caloric restriction could be associated with significant reductions in total body fat, visceral fat, abdominal fat, insulin resistance in both men and women. Exercise in the absence of accompanying weight loss can result in significant loss of total body fat and abdominal fat (obesity). Most people who exercise especially when the exercise involves weight bearing such as jogging, walking, resistance exercises gain lean body mass and may lose equivalent fat mass resulting in Zero net body weight loss. In weight loss programs where exercise and caloric restrictions constitute the principal means of weight loss process, it is therefore necessary to employ efficient and reliable measures to determine changes in body composition - fat mass loss and muscle mass gain or loss.
Such measurements can be obtained with calipers for skinfold measurement, Gulick tape for weight circumference measurement or a reliable and reproducible body composition machine.
One hour of daily moderate aerobic exercise results in as much fat mass loss as equivalent caloric restriction.
The addition of resistance exercise to energy restriction (dieting) does not appear to prevent the expected loss of fat-free mass (muscle or lean body mass) that is typically associated with caloric restriction (or dieting). The combination of resistance exercise and caloric restriction also prevents the expected reduction in basal metabolic rate or the resting energy expenditure (typically associated with weight loss not accompanied with resistance training).
A total of 7-10 miles of walking each week will prevent deteriorations in lipids (cholesterol) associated with inactivity.
Exercise that involves significant resistance load such as resistance exercise training may result in several pound increase in muscle mass which can somewhat offset decreases in volume of fat mass loss.
When a sedentary overweight person engages in a walking exercise program he/she can gain lean muscle mass in the weight bearing muscles of the lower extremities (the buttocks, thighs, legs and feet). A person can burn significant energy by carrying backpacks. Energy expenditure by the individual will be proportional to the weight of the backpack the length of time and the type of terrain (the gradient of an uphill trail vs a downhill trail). The intensity of such an activity (with the backpack) will result in increased muscle mass in the trunk, the flexor muscles and extensor muscles of the lower extremities. In other words, the increase in muscle mass in these muscles will be proportional to the intensity of the activity such as the weight of the backpack, time and distance walked and the type of terrain involved (uphill vs downhill).
When we roll out bags (luggage), we expend a whole lot less energy than when we carry the equivalent weight bags.
To be more precise in determining the effects of an activity such as carrying a backpack, one will need to consider the net vs gross energy expenditure/cost of the activity. The net energy expenditure is the gross energy expenditure minus the index exercise or activity related energy expenditure. The gross energy expenditure includes the energy expenditure accounted for by the individual’s basal metabolic rate or resting energy expenditure (which is the calorie expended by the individual’s body to maintain his/her body function such as respiration, cardiac/heart activity cellular functions etc.) The basal metabolic rate, on the other hand is influenced by the person’s body size (heavier people tend to have higher basal metabolic rate)
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Aerobic Physical Activity Guidelines for Managing Overweight/Obesity – American College of Sports Medicine 2013 Guidelines for Exercise Testing and Prescriptions:

The goal of physical activity should at least be 30 minutes/day progressing to 60 minutes/day (i.e. 300 minutes per week), >5 days/week at 40 - 60+% of aerobic capacity. This goal can also be achieved through multiple daily bouts of 10 minutes duration exercise. There is a dose effect for physical activity and weight loss - higher doses of exercise are capable of producing up to 3% or more weight loss. Any physical activity may produce some weight loss. Exercising less than 150 minutes/week results in minimal weight loss. Exercising greater than 150 minutes/week may result in moderate weight loss of 2-3kg (4.4 to 6.6lb). Exercising between 225 to 420 minutes/week may lead to 5 - 7.5kg (11 to 16.5lb) weight loss per week from baseline weight. Weight loss benefits of exercise or increased physical activity is optimized by maintenance of a relatively constant caloric intake. Your LDL-C (i.e. your bad cholesterol) could decrease by 4 - 7% and HDL-C (good cholesterol) can increase by 4 - 25% when you implement an exercise program that will involve expenditure of 1200 - 2200kcal/week. However, fat weight reduction is required for the most favorable improvement in serum lipids (cholesterol) in patients with abnormal serum lipids (abnormal cholesterol levels). When active young people go from >10,000 steps/day to <5000 steps/day (or as low as 1500 steps/day) in a 3 - 14 days period, it results in increased insulin resistance (initial steps on the way to development of type 2 diabetes mellitus), poor blood glucose control, increased adiposity (or deposition of body fat). <5000 steps/day (by adults) is a step-defined sedentary lifestyle for adults. Low active lifestyle is defined as 5000 - 7499 steps per day. Physically active lifestyle is >7500 steps/day. In general, for inactive individuals, >1000kcal per week of exercise above their weekly physical activity baseline may significantly increase their HDL-C (i.e. their good cholesterol) Resistance training can improve a variety of health-related outcomes such as muscular endurance, muscular strength, and maintenance of lean body mass. Resistance exercise training may have minimal effects on serum lipids (cholesterol). This is probably because total energy expenditure in most resistance training is often relatively moderate compared to same time spent during aerobic training of the same duration. However, resistance training exercises that involve sections of low resistance, high repetition circuit weight training performed for extended period of time (involving the expenditure of up to 300kcal or more during the session) can result in relatively high energy expenditure comparable to 30-35 minutes of moderate intensity aerobic exercise. Additional health benefits of resistance training exercise may include improvement in chronic disease risk factors such as improvement in diabetes and heart disease risk factors.

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Did you know that 5 - 10% weight loss from baseline body weight may improve obesity related medical conditions such as type 2 diabetes, high blood pressure, lipid profile (or high blood cholesterol levels), snoring or sleep apnea (excessive snoring), arthritis, low back pain, asthma, heart disease; and may prevent heart attack and stroke? Did you know that mortality (risk of death) increases with BMI: with a BMI of 22.5 to 25 you have 80% chance of reaching age 70 years; but a BMI of 35 - 40 confers you a 60% chance of reaching 70 years of age, and that with a BMI more than 40, your chance of reaching age 70 years drops to 50%
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A research presented at the American Heart Association Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013, found that consumption of sugar-sweetened sodas, sports drinks and fruit drinks was associated with 180,000 deaths around the world each year. Data collected as part of the 2010 Global Burden of Diseases Study showed that intake of sugar-sweetened beverages has been linked to 133,000 diabetes deaths, 44,000 deaths from cardiovascular diseases and 6,000 cancer deaths. Seventy eight per cent of these deaths were due to overconsuming sugary drinks and were in low and middle-income countries.

About 15.8% of total energy in American diet comes from added sugar, most of which is derived from sodas (a term used to describe carbonated sugar-sweetened beverages), fruit juice, sweetened ice tea. There is significant surge in the consumption of sugar-sweetened beverages from the late 1970s through the early 2000. During that period, daily intake of calories from sugar-sweetened beverages reached 83 kcal/person. One 12-ounce can of soda contains 40 - 50g of sugar (that is 150kcal) which is equivalent to 10 teaspoons of table sugar. Consumption of one 12-ounce can of soda a day (in the absence of any other additional sources of calories), will result in 15LB (6.8kg) weight gain in one year.

The American Heart Association recommends that adults consume 450 calories per week (36 ounces) from sugar sweetened beverages. In other words, one can consume only a total of three 12-ounce of soda per week as long as he or she abstains from consumption of sugar-sweetened beverages from other sources such as fruit juice, sweetened tea, lemonade drinks, energy drinks or coffee with added sugar or coffee creamer.
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Body contouring involves the treatment of targeted sections of a patient’s body in order to create tighter and smoother skin and a more defined body shape. Learn more about #bodycontouring.
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