At dinner last night, I just couldn’t resist dessert, the warm chocolate lava cake heaped with vanilla ice cream. I paid for it dearly this morning, exercising an additional hour, though I knew my total caloric balance was still positive since I burn only 8-10 calories a minute exercising. That extra sixty minutes on the treadmill probably only covered half the calories in the dessert. The chocolate was good, but was it worth it?
Obesity is a major health problem, as I’ve written before. It’s on the rise and has been called an epidemic, contributing to the global increase in high blood pressure, lipid disorders, and diabetes, as well as cardiovascular disease and heart failure. It turns out that, while your weight and the total amount of body fat are important, equally important is its distribution. Among post-menopausal women with normal body mass index (BMI), having elevated trunk fat was worse than having elevated leg fat. The combination of elevated trunk fat and reduced leg fat were associated with increased risk of cardiovascular disease.
Obesity is also associated with a heart rhythm problem called atrial fibrillation. In this instance, it’s not just the increase in BMI that’s important, but weight change as well. Compared with stable BMI over time, both loss and gain in BMI were associated with increased atrial fibrillation risk. So, if you’re successful dieting and losing weight, be sure to keep it off. Bouncing up and down increases risk.
Losing weight by dieting is obviously the first approach to dealing with obesity. Weight loss surgery, called bariatric or metabolic surgery, i.e., surgical procedures that alter gastrointestinal physiology, is another approach usually reserved as a last resort for the extremely obese. In a retrospective cohort study of 2,287 obese patients with type 2 diabetes who underwent metabolic surgery and were matched with 11,435 controls, metabolic surgery was significantly associated with a lower risk of major adverse cardiovascular events, with almost a 40 percent reduction in risk of heart attacks, strokes, and heart failure, along with an increase in survival. As in all observational studies, the results cannot be considered conclusive, but the outcome is certainly encouraging.
In my last column, I called attention to newly reported respiratory problems associated with vaping. More than 450 cases in 33 states have now been reported, with five deaths (and rising). The FDA thinks it may have identified the putative culprit as an oil derived from vitamin E called vitamin E acetate. The substance has been found in 10 of 18 cannabis products sampled, but not in nicotine products. Each of the cannabis products was inhaled during vaping by individuals falling ill in New York. “At least one vape product containing vitamin E acetate has been linked to each patient who submitted a product for testing,” a health department worker said.
Foods like canola oil, olive oil and almonds normally contain vitamin E. While the oil acetate is available as a nutritional supplement and for skin application, those uses have not been associated with harm. Vitamin E acetate inhaled during vaping can be an entirely different story during which the oil-like properties could be coating the lungs to cause coughing, shortness of breath, chest pain, and death.
These cases represent an emerging clinical syndrome of acute toxic lung injury associated with vaping. In response, Michigan has outlawed flavored e-cigarettes. Additional research is needed to establish the mechanism of pulmonary toxicity as well as to prove vitamin E as the definitive cause.
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