More Sun = Less Brain Tumors

Countries with low solar UVB irradiance and estimated mean serum 25(OH)D levels generally had higher age-standardized incidence rates of brain cancer.

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Neuroepidemiology. 2010;35(4):281-90. Epub 2010 Oct 14. Low ultraviolet B and increased risk of brain cancer: an ecological study of 175 countries. Mohr SB, Gorham ED, Garland CF, Grant WB, Garland FC. Source Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA 92093-0620, USA. Abstract BACKGROUND: The purpose of this study was to determine whether an inverse association exists between latitude, solar ultraviolet B (UVB) irradiance, modeled 25-hydroxyvitamin D [25(OH)D] levels and incidence rates of cancer of the brain. METHODS: Associations of latitude and UVB irradiance with age-standardized incidence rates of cancer of the brain were analyzed for 175 countries while controlling for proportion of population overweight, energy from animal sources, fish consumption, cigarette and alcohol consumption and per capita health expenditures, using multiple regression. Serum 25(OH)D levels were modeled for each country, and their association with brain cancer also was determined. RESULTS: The incidence rates of brain cancer were higher at higher latitudes (R(2) for males = 0.45, p ≤ 0.0001; R(2) for females = 0.35, p < 0.0001). After adjustment for potential confounders, UVB irradiance (p ≤ 0.0001) and modeled serum 25(OH)D were inversely associated with incidence rates. CONCLUSIONS: Countries with low solar UVB irradiance and estimated mean serum 25(OH)D levels generally had higher age-standardized incidence rates of brain cancer. Since this was an ecological study, further research would be worthwhile on the association of prediagnostic serum 25(OH)D with incidence rate in studies of cohorts of individuals. Read more at www.ncbi.nlm.nih.gov

 

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China Study; More Sun = Less Cancer!!!

Mortality from all cancers together and most major cancers in China was inversely associated with solar UVB. These associations were similar to those observed in a number of populations of European origin. Incidence of some cancer types had the same correlation with UVB. They suggest the possibility that vitamin D may reduce the incidence or improve the outcome of cancer in Chinese people.

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Cancer Causes Control. 2010 Oct;21(10):1701-9. Epub 2010 Jun 16. Relationship between cancer mortality/incidence and ambient ultraviolet B irradiance in China. Chen W, Clements M, Rahman B, Zhang S, Qiao Y, Armstrong BK. Source National Office for Cancer Prevention and Control, Cancer Institute, Chinese Academy of Medical Sciences, Chaoyang District, Beijing, China. chenwq@cicams.ac.cn Abstract BACKGROUND: Studies finding an inverse correlation of ambient solar irradiance with cancer mortality were the first to suggest that sun exposure and probably, therefore, vitamin D might protect against some cancers. Such correlation has been shown in Asian populations in some studies. We analyzed the correlation between mortality and incidence from a number of cancers and ambient solar ultraviolet (UV) B irradiance in China. METHODS: Cancer mortality data were obtained from the Second National Death Survey conducted in a sample of 263 counties in China from 1990 to 1992. National cancer registration data 1998-2002 in China were used for estimation of cancer incidence. Satellite measurements of cloud-adjusted ambient UVB intensity at 305 nm were obtained from a NASA database and GIS methods used to estimate the average daily irradiance for the 263 counties in 1990. We estimated cancer mortality rate ratios per 10 mW/(nm m(2)) change in UVB by fitting a negative binomial regression model with mortality as the response variable and UVB as the independent variable, adjusted for sex, age, and urban or rural area. RESULTS: Mortality rates for all cancers and cancers of the esophagus, stomach, colon and rectum, liver, lung, breast, and bladder were inversely correlated with ambient UVB. This correlation was present in men and women and rural residents for all these cancers but not urban residents for cancers of the esophagus, colon and rectum and liver. Lung cancer mortality showed the strongest inverse correlation with an estimated 12% fall per 10 mW/(nm m(2)) increase in UVB irradiance even if adjusted for smoking. Only incidence rates for cancers of the esophagus, stomach, colon and rectum and cervix were inversely correlated with ambient UVB. Mortality and incidence from nasopharyngeal cancer increased with increasing UVB [respectively 27 and 12% per mW/(nm m(2))]. Mortality from cancer of the cervix also increased, but to a lesser extent and mortality from leukemia was not consistently correlated with UVB irradiance. CONCLUSION: Mortality from all cancers together and most major cancers in China was inversely associated with solar UVB. These associations were similar to those observed in a number of populations of European origin. Incidence of some cancer types had the same correlation with UVB. They suggest the possibility that vitamin D may reduce the incidence or improve the outcome of cancer in Chinese people. Read more at www.ncbi.nlm.nih.gov

 

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Some Days 3 Drugs R Best; Some Days its 4 Drugs

Some Days 3 Drugs R Best; Some Days its 4 Drugs

Maybe the best news is that we have two choices to treat H. Pylori

DrR

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3-Drug Regimen for H pylori Superior in Latin America

Nancy A. Melville

July 21, 2011 — Despite data from North America, Europe, and Asia indicating that newer 4-drug regimens show superiority in the eradication of Helicobacter pylori infection than standard triple–oral antibiotic regimens, new findings from a randomized trial in Latin America indicate that the standard regimen is a more effective treatment in this setting, according to findings reported online July 20 in The Lancet.

H pylori, which accounts for an estimated 60% of cases of gastric cancer around the world, is commonly treated with a standard 3-drug regimen of a proton pump inhibitor combined with amoxicillin and clarithromycin, taken over the course of 7 to 14 days.

An emerging resistance to clarithromycin, however, is believed to be diminishing the effectiveness of the therapy. Recent meta-analyses of trials in Europe, Asia, and North America suggest that the addition of a nitroimidazole (metronidazole or tinidazole) to the regimen, given either sequentially for 10 days or concomitantly for 5 days, is significantly more effective in eradicating the infection.

In an effort to compare the efficacy of the 2 therapies in Latin America, where rates of H pylori infection and gastric cancer mortality are among the world's highest, E. Robert Greenberg, MD, from the Southwest Oncology Group Statistical Center, Cancer Research and Biostatistics, Seattle, Washington, and colleagues enrolled 1463 participants who tested positive for H pylori at 7 Latin American sites: Chile, Colombia, Costa Rica, Honduras, Nicaragua, and 2 sites in Mexico.

Between September 2009 and June 2010, participants were randomly assigned to receive the 14-day, standard, 3-drug therapy of lansoprazole, amoxicillin, and clarithromycin (n = 488); the 5-day concomitant therapy of the 3 drugs plus metronidazole (n = 489); or a sequential therapy of 5 days of lansoprazole and amoxicillin followed by 5 days of lansoprazole, clarithromycin, and metronidazole (n = 486).

The study was not masked, and the eradication of H pylori was determined by a urea breath test 6 to 8 weeks after randomization.

Using intention-to-treat analysis, the probability of eradication with the standard therapy in the study population was 82.2% (401/488), which was 8.6% higher than the 73.6% seen with concomitant therapy (360/489; 95% adjusted confidence interval [CI], 2.6 - 14.5) and 5.6% higher than the 76.5% rate seen with sequential therapy (372/486; 95% adjusted CI, −.04 to 11.6).

The findings were consistent at all 7 sites, in which neither of the 4-drug regimens showed superiority in eradication over the standard triple therapy.

From an economical standpoint, the researchers hypothesized that the 4-drug regimens would be favorable for eradication programs in low-resource settings because they require fewer antibiotic doses than the 3-drug regimens. However, their findings do not support improved efficacy in the setting studied.

"Our principal outcome measure, the probability of H. pylori eradication, was higher for 14-day standard triple therapy than for both 4-drug regimens, and these results did not vary significantly by age, sex, study site, or history of chronic dyspeptic symptoms," the authors write.

"Our results are important because they challenge those of meta-analyses showing that 4-drug regimens (triple therapy plus a nitroimidazole) given concomitantly or sequentially were clearly better than triple therapy, and they suggest that findings based primarily on data from Europe and other high-income regions might not be readily generalisable to lower-income countries."

Previous meta-analyses looking at other regions showed eradication probabilities with the 5-day concomitant and 10-day sequential regimens to be higher than 90% compared with less than 80% in the current study, and the researchers speculated that the difference may be explained by drug resistances that could be more developed in some regions than others.

"Geographical variations in the pattern of H. pylori resistance to antibiotics might account for some of the discrepancies between the results," they write.

Although Dr. Greenberg and colleagues assert that the findings of their trial suggest that implementation of population-wide H pylori elimination trials throughout Latin America to prevent gastric cancers caused by the infection is feasible, the authors of an accompanying editorial disagree.

"Policies aimed at population-wide H. pylori eradication could have individual and social repercussions," write Luiz Edmundo Mazzoleni, MD, from the Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil, and colleagues.

Among the concerns that Dr. Mazzoleni and colleagues discuss are anaphylaxis from amoxicillin, increased mortality from clarithromycin in those patients with ischemic heart disease, and the possibility of Clostridium difficile infection from use of any antibiotic.

"Even if infrequent, these complications could become important [and life threatening] when eradicating H pylori at a population level," they assert.

"Mass eradication is a major issue requiring further investigation...[it] is potentially feasible but in view of the differing socioeconomic realities of Latin American countries, doubts remain about the advisability of such a policy," the physicians warn.

The study was supported by the Bill & Melinda Gates Foundation and the National Institutes of Health. Study coauthor Douglas R. Morgan, MD, MPH, from the University of North Carolina, Chapel Hill, has submitted a patent application for a technique using molecular endoscopy to detect cancer in the gastrointestinal tract and has received funding from Axcan for his participation in a speakers' bureau. He has also received a research grant from AstraZeneca for a proton-pump inhibitor study in Hispanic populations in the United States, and from Given Imaging for ongoing efficacy studies of colon endocapsule efficacy. All other authors and the editorialists have disclosed no relevant financial relationships. Read more at www.medscape.com

 

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Supplemental Vit D? Meh!

The randomized trials of vitamin D and cardiovascular disease and diabetes have been, in general, quite inconsistent and inconclusive.



Whether the trials are of vitamin D alone or of vitamin D plus calcium, the results have been mixed and generally neutral and null, not showing a clear association.



So until we have more evidence from randomized trials that really assess the long-term balance of benefits and risks, it may be best -- the most evidence-based and wisest approach -- to use the Institute of Medicine's recommendations for vitamin D that are based on bone health. These are intakes of 600 IU/day for patients 1-70 years of age and intakes of 800 IU/day for patients 70 years of age and above, and blood levels of 25-hydroxyvitamin D of 20 ng or higher, which should meet the needs of at least 97.5% of the population in maintaining bone health. For understanding whether high-dose vitamin D has benefits beyond bone health and whether it prevents cardiovascular disease, diabetes, cancer, and many other nonskeletal health outcomes, the randomized trials of 2000 IU/day and even higher doses are in progress, and results should be available in several years.

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Does Vitamin D Prevent Cardiovascular Disease and Diabetes?

JoAnn E. Manson, MD, DrPH

I would like to talk to you today about whether vitamin D prevents cardiovascular disease and diabetes, or whether the jury is still out. Many of our patients are taking high doses, even megadoses, of vitamin D: 4000-6000 IU a day or even more with the hope and expectation that these high doses will prevent heart disease, stroke, diabetes, hypertension, and many other nonskeletal chronic disease outcomes. But do we know that vitamin D in high doses has these benefits?

Several recent reports have shed light on these issues. One of these reports was a commentary written by myself and a colleague of mine (both members of the Institute of Medicine committee on dietary recommendations for vitamin D) and published in JAMA [1] about 2 weeks ago. The other was the clinical practice guidelines from the Endocrine Society published in The Journal of Clinical Endocrinology & Metabolism.[2] Both of these reports concluded that the evidence that vitamin D prevents cardiovascular disease and most other nonskeletal health outcomes continues to be inconclusive and inconsistent.

In our commentary in JAMA, we reviewed the studies that have been conducted on this question. Most of the research has been observational. We know that association does not prove causation and that factors such as obesity or physical activity associated with higher levels of sun exposure can confound the relationship between 25-hydroxyvitamin D and the risk for diabetes or cardiovascular disease.

The randomized trials of vitamin D and cardiovascular disease and diabetes have been, in general, quite inconsistent and inconclusive. Whether the trials are of vitamin D alone or of vitamin D plus calcium, the results have been mixed and generally neutral and null, not showing a clear association. Most of these trials tested lower doses of vitamin D. However, we don't yet know that higher doses (2000 IU/day or higher) will have a favorable benefit/risk ratio.

We can't assume that more is better. More is not necessarily better when it comes to vitamin D, calcium, or many other nutrients. In fact, with vitamin D, there is a suggestion of a U-shaped relationship between 25-hydroxyvitamin D and risks for cardiovascular disease and all-cause mortality. There is a suggestion of increased risk at both low and very high levels of 25-hydroxyvitamin D.

So until we have more evidence from randomized trials that really assess the long-term balance of benefits and risks, it may be best -- the most evidence-based and wisest approach -- to use the Institute of Medicine's recommendations for vitamin D that are based on bone health. These are intakes of 600 IU/day for patients 1-70 years of age and intakes of 800 IU/day for patients 70 years of age and above, and blood levels of 25-hydroxyvitamin D of 20 ng or higher, which should meet the needs of at least 97.5% of the population in maintaining bone health. For understanding whether high-dose vitamin D has benefits beyond bone health and whether it prevents cardiovascular disease, diabetes, cancer, and many other nonskeletal health outcomes, the randomized trials of 2000 IU/day and even higher doses are in progress, and results should be available in several years. Read more at www.medscape.com

 

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Replacing Carbs With Nuts May Be Beneficial in Diabetes

Nuts are good for you and better than bran muffins!

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The Canada Research Chair Endowment of the Federal Government of Canada, the International Tree Nut Council Nutrition Research & Education Foundation, and the Peanut Institute supported this study. Two of the study authors have disclosed various financial relationships with Unilever, the Sanitarium Company, the California Strawberry Commission, the Almond Board of California, the International Tree Nut Council Nutrition Research & Education Foundation, Barilla, Unilever Canada, and/or Loblaws.

"[N]ut consumption not only improved glycemic control but also lipid risk factors for [coronary heart disease]," the study authors conclude. "We have no explanation for the lack of antioxidant effects of nuts seen with previous studies but may relate to antioxidants in wheat bran and apple concentrate used in the muffins. We conclude that mixed, unsalted, raw, or dry-roasted nuts have benefits for both blood glucose control and blood lipids and may be used to increase vegetable oil and protein intake in the diets of type 2 diabetic patients as part of a strategy to improve diabetes control without weight gain."

Limitations of this study include use of a self-reported 7-day diet history, lack of blinding for participants and dietitians, high nut consumption, and the attempt to show a dose response to nuts when the primary objective of establishing whether nuts improved glycemic control had not first been demonstrated.

"Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes," the study authors write.

Compared with muffins, the full-nut dose was associated with a significant reduction in levels of low-density lipoprotein (LDL) cholesterol. With the half-nut dose, there was an intermediate reduction in LDL cholesterol levels, but this finding did not differ significantly from the other treatments. Similar patterns were observed with improvements in the apolipoprotein (apo) B and the apoB:apoA1 ratio. There was an inverse association of nut intake with changes in levels of HbA1c (r = −0.20; P = .033) and LDL cholesterol (r = −0.24; P = .011).

Compared with muffins, the full-nut dose was associated with a relative increase in MUFAs of 8.7% energy. The full-nut dose (mean intake, 73 g/day) was associated with a decrease in HbA1c levels of −0.21% absolute HbA1c units (95% confidence interval [CI] −0.30 to −0.11; P < .001), but there was no change with the half-nut dose or muffin, according to the intent-to-treat analysis (n = 117). The half-nut dose was not significantly different from muffin, but the full-nut dose was significantly different from both the half-nut dose (P = .004) and muffin (P = .001).

For 3 months, 117 participants with type 2 diabetes were randomly assigned to receive 1 of 3 treatments, with supplements given at 475 kcal per a 2000-kcal diet as mixed nuts (75 g/day of unsalted and mostly raw almonds, pistachios, walnuts, pecans, hazelnuts, peanuts, cashews, and macadamias), muffins with similar protein content to the nuts but no MUFAs, or half portions of both. Change in HbA1c level was the main study endpoint.

"Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL [high-density lipoprotein] cholesterol and improve glycemic control, yet the exact sources have not been clearly defined," write David J. A. Jenkins, MD, from the Clinical Nutrition and Risk Factor Modification Center at St. Michael's Hospital Toronto in Ontario, Canada, and colleagues. "Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA1c in type 2 diabetes."

Mixed nuts may be a good replacement for some carbohydrates in the diabetic diet, according to the results of a randomized controlled trial reported online June 29 in Diabetes Care.

Study Synopsis and Perspective

This randomized controlled trial by Jenkins and colleagues compares the effect of a full serving of nuts vs half a serving of nuts vs half a serving of a muffin and a muffin-only serving on hemoglobin A1c (HbA1c) and lipid levels in patients with type 2 diabetes. Mixed nuts were substituted as a source of fat and proteins to replace carbohydrate foods (muffin) without changing the total energy intake for 3 months.

There are concerns about the effect of refined carbohydrates on glycemia in patients with type 2 diabetes, and studies on patients without diabetes have shown a positive effect of nut intake on cholesterol levels with no weight gain. However, the effect of substituting nuts for carbohydrates in patients with diabetes is not well known.

Clinical Context

Replacing Carbs With Nuts May Be Beneficial in Diabetes CME

News Author: Laurie Barclay, MD CME Author: Désirée Lie, MD, MSEd

Authors and Disclosures

CME Released: 07/13/2011; Valid for credit through 07/13/2012 Read more at www.medscape.org

 

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Poor Surgery (RNY or Band) Not Helped Much by Exercise

Poor Surgery (RNY) Not Helped Much by Exercise



The current study demonstrates that a 12-week exercise program after RNY or a Band type bariatric surgery failed to improve most research outcomes, but physical fitness was superior in the exercise group vs the control group.



You want good weight loss = You need a good weight loss surgery

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Moderately Intense Exercise Improves Fitness in Most Bariatric Surgery Patients CME

News Author: Laurie Barclay, MD CME Author: Charles P. Vega, MD

Clinical Context

Bariatric surgery has been demonstrated to substantially reduce weight among obese adults, and it can cure chronic illnesses such as type 2 diabetes mellitus and hypertension. However, the long-term outcomes of bariatric surgery may not reflect the fantastic improvements documented in the short term. A study by Sjöström and colleagues, which was published in the December 23, 2004, issue of The New England Journal of Medicine, examined patients 10 years after bariatric surgery. They found that although surgery promoted excellent weight loss from 0 to 2 years postoperatively, postsurgical patients gained a higher percentage of body weight between 2 and 10 years after surgery vs obese control patients. However, recovery rates from diabetes, hypertension, and hypertriglyceridemia remained superior in the surgery group vs the control group at 10 years.

Institution of exercise programs after bariatric surgery may help promote more sustained weight loss. The current randomized trial by Garg and colleagues examines outcomes of a postsurgical exercise training program.

Study Synopsis and Perspective

Rigorous exercise may be feasible and beneficial to maintain weight after bariatric surgery, according to the results of a randomized controlled trial reported online July 7 in Obesity.

"[W]e didn't know until now whether morbidly obese bariatric surgery patients could physically meet this goal," said senior author Abhimanyu Garg, chief of nutrition and metabolic diseases at University of Texas Southwestern Medical Center at Dallas, in a news release. "Our study shows that most bariatric surgery patients can perform large amounts of exercise and improve their physical fitness levels. By the end of the 12 weeks, more than half the study participants were able to burn an additional 2,000 calories a week through exercise and 82 percent surpassed the 1,500-calorie mark."

The investigators studied the tolerability and efficacy of high-volume exercise program (HVEP) in 33 obese, postbariatric-surgery patients who had undergone Roux-en-Y gastric bypass and gastric banding. Mean body mass index (BMI) was 41 ± 6 kg/m2. Participants were assigned for 12 weeks to an HVEP (n = 21) or to a control group (n = 12). All participants were advised to limit energy intake, and the HVEP group was also counseled to take part in moderate-intensity exercise resulting in energy expenditure of at least 2000 kcal/week. Repeated measures analysis allowed determination of treatment effect.

In the HVEP group, more than half (53%) of participants expended at least 2000 kcal/week during the last 4 weeks of the study, and 82% expended at least 1500 kcal/week. Compared with the control group, the HVEP group had significant improvement at 12 weeks in step count, reported time spent and energy expended during moderate physical activity, maximal oxygen consumption relative to weight, and incremental area under the postprandial blood glucose curve (group-by-week effect: P = .009 - .03).

"We found that participants in the exercise group increased their daily step count from about 4,500 to nearly 10,000 so we know that they weren't reducing their physical activity levels at other times of the day," Dr. Garg said. "We also found that while all participants lost an average of 10 pounds, those in the exercise group became more aerobically fit."

Some quality-of-life scales improved significantly in both groups. The groups did not differ significantly in changes in weight, energy and macronutrient intake, resting energy expenditure, fasting lipids and glucose, and fasting and postprandial insulin concentrations.

"HVEP is feasible in about 50% of the patients and enhances physical fitness and reduces postprandial blood glucose in bariatric surgery patients," the study authors write.

Limitations of this study include short duration, small sample size, dropout rate higher in the control group vs the HVEP group, dietary and exercise counseling provided at an individual level and not at the group level, and use of an unsealed pedometer to measure physical activity.

"Whether a HVEP helps to maintain weight loss and improvement in comorbidities in these patients remains to be evaluated in long-term studies," the study authors conclude. "The studies also need to assess how exercise over the long term affects factors that influence energy balance including energy intake, nonexercise activity levels, body composition, metabolic rate, and gastrointestinal hormones related to satiety and hunger."

The National Institutes of Health and the Southwestern Medical Foundation supported this study. The study authors have disclosed no relevant financial relationships.

Obesity. Published online July 7, 2011.

Study Highlights

All study patients had received either Roux-en-Y bypass or gastric banding surgery within 3 months of study enrollment, and all had a baseline BMI of 35.5 kg/m2 or more. Study participants were between the ages of 18 and 65 years, and they exercised less than 20 minutes per day during the previous 3 months.

Participants were randomly assigned to an exercise group or to a control group. The goal for the exercise group was to expend at least 2000 kcal/week in moderate-intensity aerobic exercise at 60% to 70% of maximal oxygen consumption. Exercise was increased gradually to achieve this goal, and participants were asked to exercise at least 5 times per week. Exercise was partially supervised during 1 to 2 sessions per week.

The control group did not receive specific exercise instructions.

Both treatment groups received similar recommendations regarding diet, with recommended calorie restrictions of 1200 to 1500 kcal/day.

Participants in the exercise group received behavioral therapy regarding exercise and diet, whereas control participants received behavioral therapy regarding diet alone.

The study interventions lasted 12 weeks.

The main study outcome was physical fitness, as measured by maximal oxygen consumption on exercise testing. Researchers also measured total physical activity levels and resting energy expenditure, and they followed body weight as well as body composition using dual-energy x-ray absorptiometry. Finally, researchers measured multiple metabolic variables and participants' quality of life.

21 patients were randomly assigned to the exercise group, and 12 patients comprised the control group. The mean age of participants was approximately 50 years, and the mean BMI was 41 kg/m2. More than 90% of participants were women.

4 participants dropped out of the control group, as did 5 participants in the exercise group.

During the last 4-week period of the study intervention, 53% of participants in the exercise group expended at least 2000 kcal/week, and 82% expended at least 1500 kcal/week. The mean number of steps daily in the exercise group increased from 5500 at baseline to nearly 10,000 at 12 weeks.

The time spent in exercise increased 3 times vs baseline levels in the exercise group but remained stable in the control group.

The maximal oxygen consumption during exercise (adjusted for body weight) increased by 10% in the exercise group but decreased very slightly in the control group.

Resting energy expenditure was similar in the exercise and control groups.

Participants in the exercise group experienced a more significant increase in total caloric intake between weeks 6 and 12 of the study.

Body weight, waist circumference, and hip circumference declined to similar degrees in the exercise and control groups, and there was a small and similar decline in percent total body fat in both groups.

The 2 treatment groups were also similar in fasting as well as in postprandial serum insulin and glucose levels. However, the mean incremental area under the curve postprandial glucose response was lower in the exercise group vs the control group.

Serum lipid and blood pressure values were also similar in comparing the exercise group vs the placebo group.

Quality of life improved at 12 weeks in the 2 treatment groups to a similar degree.

Clinical Implications

A previous study suggested that early weight loss after bariatric surgery might not be effectively sustained at 10 years. However, recovery rates from diabetes, hypertension, and hypertriglyceridemia remained superior in the surgery group vs the control group at 10 years.

The current study demonstrates that a 12-week exercise program after bariatric surgery failed to improve most research outcomes, but physical fitness was superior in the exercise group vs the control group. Read more at www.medscape.org

 

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High potassium foods (more than 200 mg per serving):



One papaya (781).



One cup of prune juice (707).



One cup of cubed cantaloupe (494) or diced honeydew melon (461).



One small banana (467).



One-third cup of raisins (363).



One medium mango (323) or kiwi (252).



One small orange (237) or one-half cup of orange juice (236).



One medium pear (208).

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Potassium Content Of Foods List What is potassium? Potassium Content Of Foods List Care Guide Potassium Content Of Foods List Potassium Content Of Foods List Aftercare Instructions Potassium Content Of Foods List Discharge Care En Espanol Potassium is a mineral that is found in most foods. Caregivers may do a blood test to check your blood level of potassium. You need to eat the right amount of foods that contain potassium to keep your blood levels in a healthy range. Why may I need to change the amount of potassium in my diet? Potassium is important to your health because it keeps fluids and minerals balanced in your body. Potassium may also help lower blood pressure and decrease your risk of having a stroke. Without enough potassium in your body, you may feel weak and your bowels may stop working. Your heart may beat very fast, or the beat may not be regular. When your potassium levels are too low, it is called hypokalemia. If you have this condition, ask caregivers for more information about it. What diet changes do I need to make? You may need extra potassium in your diet if you are taking diuretics (water pills). Diuretics and certain medicines cause your body to lose potassium. Your caregiver may also suggest that you get extra potassium if you have high blood pressure. People with kidney problems or other health conditions may need to limit potassium. Most adults need about 2000 milligrams of potassium from their diet each day. Your caregiver will tell you how much potassium you should have each day. Learn about foods that contain potassium, and how much potassium is in each food. What kinds of fruit contain potassium? The amount of potassium in milligrams (mg) contained in each fruit or serving of fruit is listed beside the item. High potassium foods (more than 200 mg per serving): One papaya (781). One cup of prune juice (707). One cup of cubed cantaloupe (494) or diced honeydew melon (461). One small banana (467). One-third cup of raisins (363). One medium mango (323) or kiwi (252). One small orange (237) or one-half cup of orange juice (236). One medium pear (208). Medium potassium foods (100-200 mg per serving): One medium peach (193). One cup of watermelon (176). One small apple (159) or one-half cup of apple juice (147). One-half cup of peaches canned in juice (158). One-half cup of canned pineapple (152). One-half cup of fresh, sliced strawberries (138). Low potassium foods (less than 100 mg per serving): One-half cup of mandarin oranges (98). Ten small grapes (93). One-half cup of sweetened applesauce (78). One-half cup of fresh blueberries (63). What kinds of vegetables contain potassium? High potassium foods (more than 200 mg per serving): One cup of tomato juice (535) or chopped or sliced tomato (400). One baked sweet potato, with skin (508). One-half of a medium avocado (450). One-half of a medium potato, with skin (422). One cup of fresh or cooked asparagus (288). One-half cup of cooked pumpkin (282). One-half cup of cooked mushrooms (277). One-half cup of fresh Brussels sprouts (247). Medium potassium foods (100-200 mg per serving): One-half cup of fresh green beans (187). One-half cup of fresh carrots (177). One-half cup of cooked zucchini, summer squash (173). One-half cup of fresh cauliflower (151). One-half cup of canned peas (147). One-half cup of fresh broccoli (143). One-half cup of frozen corn (120). Low potassium foods (less than 100 mg per serving): One-half cup of cucumber slices (88). One cup of iceberg lettuce (87). One-half cup of frozen green beans (85). What sources of protein contain potassium? High potassium foods (more than 200 mg per serving): One-half cup of cooked pinto beans (400), lentils (365), or dried peas (355). One cup of soy milk (345). Three ounces of baked or broiled salmon (319). Three ounces of roasted turkey, dark meat (259). One-fourth cup of sunflower seeds (241). Three ounces of cooked lean beef (224). Two tablespoons of peanut butter (214). Medium potassium foods (100-200 mg per serving): One ounce of salted peanuts (187). Low potassium foods (less than 100 mg per serving): One egg (55 mg). What dairy products contain potassium? High potassium foods (more than 200 mg per serving): Six ounces of yogurt (398). One cup of 2 percent white milk (377). One cup of low-fat (2 percent) cottage cheese (217). Medium potassium foods (100-200 mg per serving): One-half cup of ricotta cheese (154). One-half cup of vanilla ice cream (131). Low potassium foods (less than 100 mg per serving): One ounce of American cheese (79) or cheddar cheese (28). What other foods contain potassium? High potassium (more than 200 mg per serving): One tablespoon of molasses (498). Medium potassium foods (100-200 mg per serving): A one and one-half ounce chocolate bar (169). Care Agreement Read more at www.drugs.com

 

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Potassium is an essential nutrient used to maintain fluid and electrolyte balance in the body. A deficiency in potassium causes fatigue, irritability, and hypertension (increased blood pressure). Overdose of potassium from natural sources is nearly impossible, however, it is possible to consume too much potassium via potassium salts which can lead to nausea, vomiting, and even heart attack.

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Top 10 Foods Highest in Potassium

Potassium is an essential nutrient used to maintain fluid and electrolyte balance in the body. A deficiency in potassium causes fatigue, irritability, and hypertension (increased blood pressure). Overdose of potassium from natural sources is nearly impossible, however, it is possible to consume too much potassium via potassium salts which can lead to nausea, vomiting, and even heart attack. Potassium from natural food sources, like the ones listed below, are considered safe and healthy. The current recommended daily allowance for potassium is a whopping 3.5 grams, below is a list of high potassium foods. For more foods high in potassium please see the list of fruits high in potassium, and vegetables high in potassium. #1: Dried Herbs Long used for medicinal purposes, herbs are packed with nutrients and potassium is no exception. Dried Chervil contains the most potassium with 4.7g (135% RDA) per 100g serving, or 95mg (3% RDA) per tablespoon. It is followed by Dried Coriander (3% RDA) per Tblsp, Dried Parsley (2% RDA), Dried Basil, Dried Dill, Dried Tarragon, Ground Turmeric, Saffron, and finally Dried Oregano with 50mg (1% RDA). Click to see complete nutrition facts #2: Avocados Avocados are great when made into guacamole or in a salad. 100 grams will provide 585mg of potassium or 14% of the RDA. That is 1.1g (32% RDA) in one cup pureed, and 975mg (28% RDA) in a single avocado (201 grams). Click to see complete nutrition facts || More Fruits High in Potassium #3: Paprika and Red Chili Powder Either paprika or red chili powder add a nice kick to any dish, and with all the potassium they provide you have good reason to start adding them. Paprika provides the most potassium with 2.3g (67% RDA) per 100 gram serving, or 164mg (5% RDA) per tablespoon. Chili powder will provide 1.9g (55% RDA) per 100 gram serving or 153mg (4% RDA) per tablespoon. Click to see complete nutrition facts #4: Cocoa Powder and Chocolate Dark chocolate is an excellent source of iron and zinc in addition to potassium. Pure cocoa powder without any fat, milk, or sugar, provides the most potassium with 1.5 grams (44% RDA) in a 100g serving, or 1.3g (37% RDA) per cup, and 76mg (2% RDA) per tablespoon. Unsweetened baking chocolate provides 830mg (24% RDA) per 100 gram serving or 241mg (7% RDA) per square. Most sweetened milk chocolates will provide around 272mg (11% RDA) per 100 gram serving, and 164mg (5% RDA) per bar (1.5oz). Click to see complete nutrition facts #5: Dried Apricots, Prunes, Zante Currants, and Raisins Most common as a snack, dried apricots and prunes can also be chopped and served in a salad. A good source of fiber and many other vitamins, apricots provide 1.9g (53%RDA) of potassium per 100g serving (about 20 dried apricots). Prunes provide 1g (30% RDA) per 100g serving, or 1.4g (40% RDA) per cup. Zante currants are really a type of grape and taste very similar to raisins. Zante currants provide 892mg (25% RDA) of potassium per 100g serving, or 1.3g (37% RDA) per cup. Raisins provide almost the same amount with 825mg (24% RDA) per 100 gram serving, or 1.2g (24% RDA) per cup. Click to see complete nutrition facts #6: Pistachios and Other Nuts Pistachios are a delicious snack, and a great addition to salads. 100 grams (~3/4cup) will provide 1g (30% RDA) of potassium. Other nuts high in potassium include Beechnuts (29% RDA per 100g), Ginko nuts (29% RDA), Chestnuts (28% RDA), Almonds (21% RDA), Hazelnuts (19% RDA), Cashews (18% RDA), Pine nuts (17% RDA), Coconuts (16% RDA), and Walnuts (15% RDA). Click to see complete nutrition facts #7: Seeds (Pumpkin, Squash, Sunflower, and Flax) A popular food in the Middle East and East Asia pumpkin and squash seeds contain about 919mg (26% RDA) of potassium per 100g serving, 588mg (17% RDA) per cup. If you can't find these in your local supermarket you will surely find them in Middle Eastern or East Asian specialty stores. Alternatively, you can also save any pumpkin and squash seeds you have and roast them in your oven. The seeds are typically eaten by cracking the outer shell and eating the seed inside. Sunflower seeds are also a good source of potassium, providing 850mg (24% RDA) per 100 gram serving, or 1.1g (31% RDA) per cup. Flax seeds provide 813mg (23% RDA) of potassium per 100 gram serving, or 1.4g (39% RDA) per cup, and 81mg (2% RDA) per tablespoon. Click to see complete nutrition facts. Buy Pumpkin Seeds from Amazon.com #8: Fish (Pompano, Salmon, Halibut, Tuna) Fish has many health benefits and is a great source of potassium. Pompano provides the most with 636mg (18% RDA) per 100 gram serving, or 540mg (15% RDA) per fillet (3 ounces, 85 grams). It is followed by Salmon which provides 534mg (15% RDA) per 3 ounce serving, Halibut, Yellow Fin Tuna, Lingcod, Mackerel, Anchovies, Herring, Cod, Snapper, Rockfish, Tilefish, Grouper, and finally Trout with 394mg (11% RDA) in a 3 ounce serinvg. Cooking fish with dry heat is the best way to preseve the potassium content. Click to see complete nutrition facts #9: Beans White beans provide the most potassium with 561mg (16% RDA) per 100 gram serving, 1g (29% RDA) per cup cooked. White beans are followed by Adzuki Beans, Soy Beans, Lima Beans, Pinto Beans, Kidney Beans, Great Northern Beans, Navy Beans, Pigeon Peas, Cranberry (Roman) Beans, French Beans, Lentils, Split Peas, Black Beans, Hyancinth, and finally Yardlong Beans with 539mg (15% RDA) per cup cooked. Click to see complete nutrition facts #10: Dates (Medjool) Dates are great as a snack, as an addition to fruits salads, or even savory stews. Medjool dates provide 696mg (20% RDA) per 100 gram serving, or 167mg (5% RDA) in a single date. Click to see complete nutrition facts Read more at www.healthaliciousness.com

 

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Foods High in Sodium



The following foods are high in sodium and should be limited in the diet.

Meat, Poultry, Fish and Other Meat Substitutes

Dairy

Main Dish Items

Grains, Cereals, Soups and Snack Foods

Vegetables

Spices, Condiments and Sauces

Food Additives

Amplify’d from www.pamf.org

Foods High in Sodium The following foods are high in sodium and should be limited in the diet. Meat, Poultry, Fish and Other Meat Substitutes Dairy Main Dish Items Grains, Cereals, Soups and Snack Foods Vegetables Spices, Condiments and Sauces Food Additives Meat, Poultry, Fish and Other Meat Substitutes Luncheon and cured meats including processed turkey/chicken, ham, bologna, salami, bacon, Canadian bacon, corned beef, pastrami, liverwurst, frankfurters, sausages, dried meat or dried fish. Canned foods including chicken, tuna and salmon, shellfish such as shrimp, crab, clams oysters, scallops and lobster. Soy protein products including marinated tofu or miso. Back to top Dairy Cheese, in particular processed cheeses including American and other processed cheese products, blue cheese, Roquefort parmesan cheese, feta cheese and cottage cheese. Milk-based drinks including buttermilk, Dutch process cocoa and instant cocoa mixes. Back to top Main Dish Items Commercially prepared main entrees including most frozen dinners or frozen main entrees, pot pies, canned main entrees such as hash, stew, chili, entrees with seasoning mixes such as macaroni and cheese. Most Asian foods including Chinese and Japanese foods made with teriyaki or soy sauce; and East Indian, Thai and Vietnamese unless prepared without added sauces containing salt or sodium products. Most Mexican foods including tacos, enchiladas, burritos and tamales. Pizza, lasagna, manicotti, ravioli, quiche, soufflés, blintzes and cheese rarebit. Back to top Grains, Cereals, Soups and Snack Foods Cereals and instant hot cereals, cold cereals containing 200 mg or more of sodium. Salted snack foods salted pretzels, salted crackers and chips, salted popcorn. Bake goods including cakes, cookies, pies, pastries, sweet rolls, doughnuts, pancakes, waffles, biscuits and muffins. Grains including rice or noodles with seasoning packets and sauces, such as Ramen noodles, rice pilaf, instant potatoes and stuffing mix. Soups including canned or packaged. Back to top Vegetables Canned including vegetables, vegetable juices, vegetables with seasoned sauces, pickled vegetables, olives, pickles and sauerkraut. Canned beans including kidney and garbanzo. Potatoes including au gratin, scalloped, packaged with sauces and seasoning mixes. Back to top Spices, Condiments and Sauces Spices and seasonings including salt, seasoning salts such as garlic, onion and celery salt, meat tenderizers, monosodium glutamate (MSG) and bouillon. Sauces including soy sauce, teriyaki sauce, Worcestershire sauce, steak sauce, barbecue sauce, smoke-flavored sauces, gravies, marinades, pasta sauces like marinara and alfredo, chili sauce, cocktail sauce, tomato puree and tomato sauce. Condiments and dressings including pickle relish, catsup, mayonnaise, commercial and packaged salad dressings. Back to top Food Additives Sodium is often added to food in other forms besides salt such as the following: Monosodium glutamate (MSG): a flavor enhancer Baking soda and baking powder: found in many baked goods Disodium phosphate: found in quick-cooking cereals and processed cheeses Sodium alginate: used in many chocolate milks and ice creams Sodium benzoate: used as a preservative in many condiments such as relishes, sauces and salad dressings Sodium hydroxide: used in food processing for softening and loosening skins of olives and certain fruits and vegetables Sodium nitrite: used in curing meats and sausages Sodium propionate: used in some breads and cakes to inhibit mold growth and in pasteurized cheese Sodium sulfite: used to bleach certain fruits such as maraschino cherries and glazed or crystallized fruits to be artificially colored; as a preservative in some dried fruits such as prunes Last Reviewed: March 2010 Read more at www.pamf.org

 

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Sodium is an essential nutrient required by the body for maintaining levels of fluids and for providing channels of nerve signaling. Deficiency of sodium is rare, however, can occur in people after excessive vomiting or diarrhea, in athletes who intake excessive amounts of water, or in people who regularly fast on juice and water.

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Top 10 Foods Highest in Sodium

Sodium is an essential nutrient required by the body for maintaining levels of fluids and for providing channels of nerve signaling. Deficiency of sodium is rare, however, can occur in people after excessive vomiting or diarrhea, in athletes who intake excessive amounts of water, or in people who regularly fast on juice and water. Over-consumption of sodium is far more common and can lead to high blood pressure which in turn leads to an increased risk of heart attack and stroke. The current recommended daily allowance for sodium is 2400mg, however, the American Heart Association recommends that people with high blood pressure eat less that 1500mg per day, or less than 3/4 of a table spoon of salt. Since sodium is required by all life to exist, it is naturally found in all foods and rarely does salt ever need to be added. Steps you can take to ensure low sodium eating include: avoiding canned foods, avoiding pickled food, choosing low sodium cheeses, and substituting herbs and other spices in place of salt. Below is a list of high sodium foods, almost all these foods should be avoided.

#1: Table salt, baking soda, and baking powder Table salt is 40% sodium by weight, and easily the number one source of sodium for almost everyone. 100 grams of table salt (1/3 cup) provides 38,000 mg of sodium or 1615% of the RDA. One teaspoon of salt provides 2325mg of sodium or 98% of the RDA. One teaspoon of baking soda provides 1368mg of sodium (57% RDA), and one teaspoon of baking powder contains 530mg (22% RDA). Click to see complete nutrition facts.

#2: Bouillon cubes, Powdered Broths, Soups, and Gravies

Salt is widely used as an agent to dry and preserve foods and soup broths are no exception. A typical 5 gram bouillon cube contains 1200mg of sodium or 50% of the RDA.

#3: Soy Sauce, Other Sauces, and Salad Dressings Soy sauce is commonly added to East Asian cooking, and now comes in low sodium varieties which are recommended, check nutrition facts of specific products for sodium content. One teaspoon of Tamari (Soy only) soy sauce contains 335mg (14% RDA) and one teaspoon of Shoyu (Wheat and Soy) Soy Sauce contains 282mg of sodium (12% RDA). In addition to soy sauces, be sure to check labels of most sauces and salad dressings in general, as these foods can be surprising high in sodium. Click to see complete nutrition facts

#4: Yeast Extract Spread (Marmite) Yeast extract spread is common in British cultures and is a good vegan source of vitamin B12 and protein. However, the spread also contains a lot of sodium providing 216mg (9% RDA) per teaspoon. Click to see complete nutrition facts

#5: Salami, Bacon, and Cured Meats Salt has long been used as a preservative for various meats, and so it is not surprising to find a high amount of sodium in them. One slice of bacon (8 grams) contains 194mg of sodium (8% RDA), while one slice of salami (10g) contains 226mg (9% RDA), and 1 large piece of beef jerky (20g) contains 443mg of sodium or 18% RDA. Click to see complete nutrition facts

#6: Sun Dried Tomatoes Sun Dried Tomatoes are delicious in a sandwich or as an ingredient in pasta sauce. 100 grams (about 2 cups) will provide 2095mg of sodium or 87% of the RDA. A single piece (2g) contains 42mg of sodium (2% RDA). Click to see complete nutrition facts.

#7: Cheese Most cheeses are packed with sodium, and combined with high cholesterol levels, can be a disaster for your heart and cardiovascular health. The cheeses with the most sodium per 100 gram serving (about 5 one inch cubes) are Roquefort (75% RDA), Cheez Whiz (71% RDA), Parmesan (71% RDA), Cheddar (66% RDA), Swiss (65% RDA), Blue (58% RDA), Romano (50% RDA), Feta (47% RDA), Edam (40% RDA), Provolone (37% RDA), Camembert (35% RDA), Gouda (34% RDA), Fontina (33% RDA), Limburger (33% RDA), Mexican blend (32% RDA), Tilsit (31% RDA), and Mozzarella (31% RDA). Click to see complete nutrition facts

#8: Snack Foods (Pretzels, Cheese Puffs, and Popcorn) It should not be news that most processed snack foods are bad for you, and their high sodium content is just another reason not to eat them. 100 grams of pretzels (15 medium twists) contain 1715mg (71% RDA) of sodium. Cheese puffs (~15% RDA per oz) and regular popcorn (~12% RDA per oz) are just as bad. As with all snack foods, be sure to check the labels for specific information. Click to see complete nutrition facts.

#9: Pickled Foods Pickled foods are typically pickled with salt and thus have very high sodium contents. 100 grams of olives, for example, will provide 1556mg (65% RDA) of sodium. That is 3% of the RDA per large olive, or 1/5 of your total recommended daily allowance in 7 olives! As for dill pickles, a single large pickle will pack half of the RDA for sodium! Click to see complete nutrition facts.

#10: Saltwater Crab While crab is an excellent source of b12 and omega 3 fats, it should be eaten in moderation due to its sodium content. 100 grams provides 1072 mg of sodium (45% RDA), which is 1436mg (60% RDA) in a single leg of Alaska King crab. Click to see complete nutrition facts Read more at www.healthaliciousness.com

 

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