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Dr K K Aggarwal

Alcohol: Benefits Vs Risk

By Dr K K Aggarwal
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  1. There is consensus that nondrinkers should not start and the ones who drink can continue provided they do so in moderation and in absence of contraindications.
  2. Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to them even if they would agree to drink is not justified.
  3. The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic stroke, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a substantial mortality benefit relative to abstention or rare drinking.
  4. For young to middle–aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer).
  5. Women who drink alcohol should take supplemental folate to help decrease the risk of breast cancer.
  6. Men under the age of 45 may also experience more harm than benefit from alcohol consumption. In this age group, moderate alcohol use is unlikely to provide any mortality benefit, but consumption of less than one drink daily appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even this level of alcohol use is dangerous.
  7. Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 g per day. Medically safe limits are 10 g in one hour, 20 g in a day and 70 g in a week. (50% for the women).

Vitamin D intake associated with reduced risk for Crohn’s disease

By Dr K K Aggarwal
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Increased intake of vitamin D may significantly reduce the risk for Crohn’s disease (CD) in women, according to an article published online December 12 and in the March issue of the journal Gastroenterology.

  • This study involved 72,719 women who returned the 1986 questionnaire. They had data on both vitamin D intake and physical activity and did not have a history of CD or ulcerative colitis (UC).
  • Diagnosis of CD was based on a typical history of 4 weeks or longer and was confirmed by radiologic, endoscopic, or surgical evaluation.
  • The diagnosis of UC was based on typical clinical presentation of 4 weeks or more and endoscopic, radiologic, or surgical evaluation.
  • Mean age of the participants at baseline was 53 years, mean body mass index (BMI) was 25.4 kg/m2, mean physical activity was 13.2 metabolic hours per week, 94.5% were white and 36.6% never smoked.
  • A documented 122 cases of CD and 123 cases of UC were recorded during 1,492,811 person–years of follow–up. The median predicted 25(OH)D level was 27.6 ng/mL.
  • Women in the lowest quartile of predicted 25(OH)D level compared with those in the highest quartile had a higher body mass index, were less active, tended to reside in the Northern or Midwestern regions of the United States, and had lower intake levels of dietary or supplemental vitamin D. The median age of diagnosis of CD was 64.0 years; for UC, it was 63.5 years.
  • The median interval between assessment of plasma 25(OH) D levels and disease diagnosis was 12 years for UC and 10 years for CD.
  • For every 1 ng/mL increase in predicted 25(OH)D level, the risk for CD was reduced by 6%.
  • For UC, there was also a reduction in risk, but it was non-significant at 4%.
  • Women in the highest two quartiles of 25(OH)D levels had multivariate HRs of 0.50 and 0.55, respectively, for CD.
  • Each 100 IU/day increase in total intake resulted in a 10% reduction in UC risk and a 7% reduction in CD risk.
  • For vitamin D intake from diet and supplements based on quartile distribution, there was a significant linear inverse trend for vitamin D intake and UC risk, but this trend was weaker for CD.
  • Intakes of 800 IU/day or higher resulted in greater reductions in the risks for UC and CD.
  • Vitamin D intake was inversely associated with the risks for CD and UC, vitamin D insufficiency or deficiency was an important mediator in the pathogenesis of UC and CD, and assessment of vitamin D status should be a part of the assessment of inflammatory bowel diseases.

Echo for Long–Term Risk after Stroke

By Dr K K Aggarwal
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A simple risk prediction model may help identify ischemic stroke patients at a higher risk of future adverse outcomes. Age, chronic renal failure, and the amount of calcification around the aortic root were predictive of death at about 4 years after nonhemorrhagic stroke said Dr Avinash Murthy at Albany Medical Center in Albany, N.Y at the annual meeting of the American Society of Echocardiography (ASE).

The doctors assigned 2 points for each decade over 40 years, 11 points for renal failure, and 3 points for aortic root sclerosis. The high–risk group –– more than 11 points –– had a mean survival estimate of 39 months, compared with 49 months for the moderate–risk group (5–10 points) and 62 months for the low-risk group (0–5 points).

Most stroke patients undergo an echocardiography exam at the index admission to look for patent foramen ovale, shunt, or embolus and data about aortic root sclerosis is already available.

Nine modifiable risk factors for heart attack

By Dr K K Aggarwal
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The majority of known risk factors for heart attack disease are modifiable by specific preventive measures.

Nine potentially modifiable factors: include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, and one should daily consume of fruits and vegetables and do regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10–year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one–half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

Snorers at risk of sudden death

By Dr K K Aggarwal
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The interrupted night time breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the journal Sleep has suggested that the risk is present among all people with obstructive sleep apnea. The size of the increased mortality risk was found to be surprisingly large.

The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, the researchers collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.

It is fruit juice which increases the risk of diabetes and not the fruits

By Dr K K Aggarwal
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A research published in the British Medical Journal has shown that eating blueberries, apples and grapes may be linked to a reduced risk and type 2 diabetes. However, increased consumption of fruit juice was linked to a higher risk.

It is a typical Ayurvedic teaching that one should eat fruits and not take fruit juice unless one is sick when digestion is weak. It is a myth that eating grapes can cause diabetes.

The well–known saying that eating an apple a day keeps the doctor away is true from this study especially green apples, which are known to be more health–friendly then the red apples.

The answer is simple… anything which is natural cannot be harmful. Fruits are natural but juices are not.

Snorers at Risk of Sudden Death

By Dr K K Aggarwal
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The interrupted night time breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the journal Sleep has suggested that the risk is present among all people with obstructive sleep apnea. The size of the increased mortality risk was found to be surprisingly large.

The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, the researchers collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.