Effects of whey peptides on cardiovascular disease risk factors.

Previous studies have shown that peptides derived from milk proteins can improve blood pressure. Therefore, the authors tested the blood pressure-lowering effects of a hydrolyzed whey protein supplement rich in bioactive peptides. In a 6-week controlled study, 30 prehypertensive or stage 1 hypertensive subjects (blood pressure >or=120/80 mm Hg and

Dietary and nutraceutical options for managing the hypertriglyceridemic patient.

Scientific evidence continues to accumulate regarding fasting serum triglycerides as an independent risk factor for coronary heart disease. In response, the National Cholesterol Education Program has revised the acceptable level of fasting triglycerides from <200 mg/dL to <150 mg/dL. A significant percentage of Americans suffer from hypertriglyceridemia, and considering the expanding numbers of individuals who are physically inactive, overweight, and suffering from the metabolic syndrome, it is expected that these numbers will continue to rise over the next decade. Fortunately, nutraceutical and lifestyle options have been shown to substantially and consistently reduce this risk factor. This review will focus on management options for the hypertriglyceridemic patient with an emphasis on nicotinic acid, pantethine, fish oils (eicosapentaenoic and docosahexaenoic acids), and modified carbohydrate diets.

Are your patients with risk of CVD getting the viscous soluble fiber they need?

A diet that includes 5 to 10 g/d of viscous soluble fiber reduces cardiovascular disease (CVD) events and death independent of baseline risk. Consuming foods rich in viscous soluble fiber reduces low-density lipoprotein cholesterol (LDL-C) blood levels 10% to 15% with expected reduction in CVD events by 10% to 15%. Routinely counsel adults at risk of CVD to promote a healthy diet: assess dietary fiber consumption; recommend specific foods rich in viscous soluble fiber; monitor LDL-C levels and encourage increased dietary fiber intake at follow-up visits; motivate patients to comply with recommendations.

Rapid HIV testing. Wait time reduced from days to minutes.

Recent breakthroughs in technology have produced tests for HIV antibody that are highly accurate and easy to use and can give a preliminary result in 20 minutes or less. These rapid HIV tests will be used increasingly in labor and delivery wards, emergency departments, urgent care centers, and the primary care office. They have unique applications for healthcare worker exposures, military operations, public health venues, and developing countries. In this article, Drs Keenan, Keenan, and Branson discuss the advantages and limitations of rapid HIV testing in various settings.

Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial.

OBJECTIVES: We assessed the short-term antihypertensive effects of soluble fiber-rich whole oat cereals when added to a standard American diet. In addition, multiple assessments of insulin sensitivity were conducted. STUDY DESIGN: This was a randomized, controlled, parallel-group pilot study designed to compare an oat cereal group (standardized to 5.52 g/day beta-glucan) to a low-fiber cereal control group (less than 1.0 g/day total fiber) over 6 weeks. POPULATION: A total of 18 hypertensive and hyperinsulinemic (= 10 U/mL or more) men and women completed the trial. OUTCOMES MEASURED: Primary study outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Secondary outcomes included blood lipid, fasting glucose, and insulin levels and side effects related to elevated blood pressure and increased dietary fiber intake. RESULTS: The oat cereal group experienced a 7.5 mm Hg reduction in SBP (P <.01) and a 5.5 mm Hg reduction in DBP (P <.02), while there was virtually no change in either SBP or DBP in the control group. In the oat cereal group, a trend was observed for a lower total insulin response to a glucose load, suggesting improved insulin sensitivity. However, this could not be confirmed using estimates from the Bergman Minimal Model, perhaps because of our small sample size. The oats group experienced a significant reduction in both total cholesterol (9%) and low-density lipoprotein cholesterol (14%). CONCLUSIONS: The addition of oat cereals to the normal diet of patients with hypertension significantly reduces both SBP and DBP. Soluble fiber-rich whole oats may be an effective dietary therapy in the prevention and adjunct treatment of hypertension.

Do whole-grain oat cereals reduce the need for antihypertensive medications and improve blood pressure control?

OBJECTIVES: Our study compared 2 whole grain oat-based cereals with 2 refined grain wheat-based cereals to determine their effects on the need for antihypertensive medications in people with high blood pressure (BP). STUDY DESIGN: This 12-week, randomized controlled parallel-group trial with = 6 weeks of voluntary follow-up was designed to investigate the antihypertensive effects of oats. After 4 weeks of baseline feeding, medication dose was maintained or reduced by half or completely throughout the middle 4 weeks of the study. In the final 4 weeks, participants continued cereal consumption; medication was adjusted according to the protocol. POPULATION: Men and women (n = 88) being treated for hypertension with a mean baseline BP below 160/100. OUTCOMES MEASURED: Primary study outcomes included change in SBP and DBP as well as antihypertensive medication reduction. Secondary measures included blood lipid, fasting glucose, and insulin levels and side effects related to elevated BP and increased dietary fiber intake. RESULTS: Seventy-three percent of participants in the oats group versus 42% in the control group were able to stop or reduce their medication by half. Treatment group participants whose medication was not reduced had substantial decreases in BP. The oats group experienced a 24.2-mg/dL reduction in total cholesterol levels, a 16.2-mg/dL decrease in low-density lipoprotein cholesterol levels, and a 15.03-mg/dL drop in plasma glucose levels vs controls. CONCLUSIONS: Results suggest that a diet containing soluble fiber-rich whole oats can significantly reduce the need for antihypertensive medication and improve BP control. Considering the lipid and glucose improvements as well, increased consumption of whole oats may significantly reduce cardiovascular disease risk.

Wax-matrix extended-release niacin vs inositol hexanicotinate: a comparison of wax-matrix, extended-release niacin to inositol hexanicotinate "no-flush" niacin in persons with mild to moderate dyslipidemia.

BACKGROUND: Nicotinic acid (NA), long used for the treatment of dyslipidemia, has shown problems with undesirable side effects and safety issues. Wax-matrix, extended-release niacin (WMER) and inositol hexanicotinate (IHN) have both been formulated to increase patient tolerability. Several trials of WMER demonstrated good efficacy in improving dyslipidemia; however, there are few scientific data on the use of IHN. OBJECTIVE: This study was designed to compare the efficacy and tolerability of WMER and IHN to each other and placebo to help clinicians make an informed choice of NA agents. METHODS: This was a 6-week blinded, placebo-controlled trial comparing 1500 mg/d of WMER with 1500 mg/d IHN. Subjects with mild-to-moderate dyslipidemia (low-density lipoprotein = 130-190/dL) were randomized, after a 4-week diet lead-in period, to three parallel study arms (40 subjects/arm). Diet, pill compliance, and side effects were monitored as well as lipid and blood chemistry profiles (baseline, 6 weeks). A dose-reduction protocol was included for subjects who did not tolerate the 1500-mg dose of NA. A pharmacokinetic substudy was conducted on subjects from the WMER (n = 5) and IHN (n = 5) groups. RESULTS: WMER demonstrated significant improvements in total cholesterol = -11%, low-density lipoprotein = -18%, high-density lipoprotein = +12%, and non-high-density lipoprotein = -15% (P < .001), whereas IHN and placebo showed no significant improvement in lipids. All groups had good medication compliance and treatment tolerance with only one dropout in the WMER group as the result of flushing. Blood chemistries showed small (24%-27%) mean increases in hepatic transaminases; six subjects completed the study at reduced dosage protocol with good lipid results. Pharmacokinetics demonstrated an intermediate release and absorption rate for WMER over 6 hours and IHN showed no evidence of bioavailability. CONCLUSION: WMER demonstrated good tolerance and efficacy and extended-release kinetics. IHN was well tolerated but was no better than placebo in lipid improvement and showed no evidence of bioavailability.

The effects of concentrated barley beta-glucan on blood lipids in a population of hypercholesterolaemic men and women.

Barley, like oats, is a rich source of the soluble fibre beta-glucan, which has been shown to significantly lower LDL-cholesterol (LDL-C). However, barley foods have been less widely studied. Therefore, we evaluated the LDL-C-lowering effect of a concentrated barley beta-glucan (BBG) extract as a vehicle to deliver this potential health benefit of barley. In a 10-week blinded controlled study, subjects were randomized to one of four treatment groups or control. Treatment groups included either high molecular weight (HMW) or low molecular weight (LMW) BBG at both 3 and 5 g doses. Treatment was delivered twice per day with meals in the form of two functional food products: a ready-to-eat cereal and a reduced-calorie fruit juice beverage. Levels of total cholesterol, LDL-C, HDL-cholesterol (HDL-C), and TAG were determined at baseline and after 6 weeks of treatment. The study group comprised 155 subjects. All treatments were well tolerated and after 6 weeks of treatment the mean LDL-C levels fell by 15 % in the 5 g HMW group, 13 % in the 5 g LMW group and 9 % in both the 3 g/d groups, versus baseline. Similar results were observed for total cholesterol. HDL-C levels were unchanged by treatment. Concentrated BBG significantly improves LDL-C and total cholesterol among moderately dyslipidaemic subjects. Food products containing concentrated BBG should be considered an effective option for improving blood lipids.

Retracted: Effects of Whey Peptides on Cardiovascular Disease Risk Factors.

Previous studies have shown that peptides derived from milk proteins can improve blood pressure. Therefore, the authors tested the blood pressure-lowering effects of a hydrolyzed whey protein supplement rich in bioactive peptides. In a 6-week controlled study, 30 prehypertensive or stage 1 hypertensive subjects (blood pressure ≥120/80 mm Hg and ≤155/95 mm Hg) were randomized to receive 20 g/d of either a hydrolyzed whey protein (active treatment) or an unmodified whey protein (control treatment). Blood pressure, blood lipids, safety measures, side effects, and diet were evaluated throughout the trial. After completion of treatment, a 4-week follow-up was conducted. There was a mean reduction of 8.0+3.2 mm Hg in systolic blood pressure (P<.05) and of 5.5±2.1 mm Hg in diastolic blood pressure (P<.05) in the treatment group compared with the control group. Low-density lipoprotein cholesterol and high-sensitivity C-reactive protein were significantly improved by treatment. Whey-derived peptides might be a viable treatment option for prehypertensive and/or stage 1 hypertensive populations.

Treatment of patients with lipid disorders in the primary care setting: new treatment guidelines and their implications.

Coronary heart disease (CHD) remains a major cause of morbidity and mortality throughout North America. The role played by lipid abnormalities is now well established, and primary care physicians can play a major role in reversing the increasing prevalence of CHD by following the recommended guidelines of the National Cholesterol Expert Panel (NCEP ATP-III). While many physicians are aware of the importance of lowering lipid levels, a large number of patients still fail to reach their treatment goals. It is therefore important to identify patients at risk of developing coronary events due to abnormal lipid profiles and to quickly implement effective prevention programs. Although diet and other lifestyle modifications should form the basis of lipid management, the addition of lipid-modifying drugs is often necessary. Several lipid-modifying agents are available, but the proven efficacy and good tolerability of statins has increasingly made them the drugs of choice.

Hypercholesterolemia.

Preview Many patients think they have to exclude meat (beef, pork, lamb, veal, and processed meats) from their diet to lower their lipid levels. This restriction is unnecessary and deprives them of the valuable nutrients found in meat. Instead, they should concentrate on selecting lean cuts, controlling portions, and reducing consumption of high-fat foods. The authors examine the typical American diet and offer practical guidelines for making choices that include meat and reduce cholesterol levels.

A solubilized cellulose fiber decreases peak postprandial cholecystokinin concentrations after a liquid mixed meal in hypercholesterolemic men and women.

Viscous dietary fibers can modify the alimentary responses to a meal and improve glucose tolerance. There may be a relationship between the effect of these fibers in the gut and the ability of the hormone cholecystokinin (CCK) to slow gastric emptying and affect glucose homeostasis. We investigated the acute and long-term (adaptive) glucose and CCK responses to liquid mixed test meals, with or without 5 g of solubilized cellulose (SC), a novel viscous fiber, in 33 hypercholesterolemic men and women. In the acute study, there was a lower peak CCK concentration (P = 0.01) after a SC-containing test meal compared with a fiber-free test meal. The CCK area under the curve responses also tended to be lower after the fiber-containing meal (P = 0.08). After a 6-wk intervention with 2.5 g of SC or placebo twice daily, fasting plasma glucose concentration tended to decrease in the SC group, whereas it increased in the control group (for between-group difference in change, P = 0.13). There were no differences between the groups in the changes from baseline to the end of the study in any other variable. There were significant gender differences in several variables at baseline. These findings support the hypothesis that CCK may mediate the effect of viscous fibers on glucose metabolism. The gender differences in glucose and CCK may explain some of the discrepancies in the results of similar experiments reported to date.

Cómo estar seguro de que el anciano toma suficiente zinc? / How is secure of that the old man to ingest sufficient zinc?

La mayoría de los ancianos prefieren como fuente de zinc los alimentos más que los suplementos (que además pueden alterar el metabolismo del cobre y del hierro). La inclusión en su dieta diaria de una cantidad moderada de carne, ave y pescado aumentará los aportes de zinc y, junto con los restantes nutrientes esenciales, contribuirá a mejorar su situación nutricional general