The Effect of Apples on Lipid Levels

Dr. Bev Blessing CNP, PHD

I love apples. They are one of my favorite fruits and I eat them routinely. So I was excited today when the news reported that apples lower LDL levels in women. MSN reported that Florida State University studied the effect of apple ingestion daily over a period of six months in a group of women between the ages of 45-65. What they found was that after six months this group had a 23 percent decrease in bad LDL cholesterol.  This is a significant finding.  We know that physiologic changes occur in women at the time of menopause that cause their LDLs to rise and the HDLs to decrease.  It is thought that leads to an increase the amount of inflammation and plaque in the vessels, limiting flow and ultimately completely blocking off the vessel in some women. The result: A heart attack. This is clearly a simplified version of the process but this change in the LDL is one of the factors that make the menopausal woman more susceptible for heart disease after menopause.  Since menopause is essentially inevitable for women, anything we as women can do to mitigate any detrimental effects will be helpful. That is why the apple study is significant.

The researchers used dried apples- about 1/3 cup daily. That is roughly equivalent to a medium sized apple daily.  They compared the group eating the apples with women who ate a different dried fruit.  They did not see the same changes in the other group. They also did not study fresh apples, but the researchers felt the finding would be the same.  The group did increase their calories slightly in eating the dried apples, but overall noted a slight decrease in weight.  The researchers speculated that the weight loss could also be a factor in the results.  Overall, they are unsure the exact mechanism of the decrease, but they also noted a decrease in C reactive protein in this group, which is an indicator of inflammation in the cells.


What is truly interesting to note is the effect of the apples on the lipid levels, which is similar to the effect that estrogen has on those levels.  Remember, estrogen has been shown to have some great preventive qualities when it comes to lipids, especially in the earlier phases of menopause.  Bottomline: When looking at some of the cardiovascular effects of estrogen and other lipid-lowering therapies in postmenopausal women, most researchers are giving the nod to a combination of strategies to include diet (apples of course), exercise, weight control, and hormone therapy as some of our strongest defenses in prevention and treatment.


If you would like to look at some of the studies they can be found at:
http://www.msnbc.msn.com/id/42555503/ns/health-womens_health/
http://circ.ahajournals.org/cgi/content/full/93/10/1928
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Dr. Jacome, A Medical Student's Perspective

Sana Khan, Medical Student

Recently I was privileged with an intriguing opportunity that few medical students acquire during their training years. I was thrilled to complete an Ob/Gyn rotation with one of the regions top robotic surgeons - Dr. Enrique Jacome. This was no ordinary experience; it was an educational experience for the mind, body and soul. From the moment he would greet the patient, it was so gratifying to observe how he pleasantly evolved the conversation and tailored it to every patient’s individual needs. No patient left without a thorough understanding about their diagnosis or their upcoming surgical procedure. He is one of the most dedicated physicians I have ever encountered. The dedication doesn’t end at providing medical care with excellence; He commits his valuable time to countless public projects and research to promote healthy lifestyles.

      In the surgical suite, Dr. Jacome works with elegance and precision. His control over the Da Vinci is flawless and I truly believe he has maximized this robot’s surgical potential. Not all robotic surgeons will present like Dr. Jacome, he bears a burning passion for the device, and he respects its capability. It is so motivating and refreshing to see a well established physician still arrive at work every morning with such a great attitude and sustained patience into the late evening hours. He is a gift to this beautiful Southern California community! I truly hope that in my career as a physician I can emulate his outstanding qualities, provide my own patients with such compassion and excellent medical care! 

Sincerely,

Sana Khan                                                   

4^th year Medical Student                                            

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Do I Need To Take Supplemental Calcium To Treat Or Prevent Osteoporosis?

Dr. John D. Carr M.D.

The question of whether to take supplemental calcium to treat or prevent osteoporosis is discussed often in the media and in my practice. The current dogma is that since bone contains alot of calcium, if you lose bone (osteopenia or osteoporosis), then supplementing with calcium will correct the problem.

The truth is that bone loss does NOT represent a calcium deficiency. The only reason to take extra of anything is if the body is deficient in the substance. The reason that most women ( and a growing number of men) lose bone is primarily because they lose the hormones necessary to grow bone, especially testosterone.

Testosterone is the most important bone building hormone in the human body. The primary reason that bone loss occurs in peri-menopause and beyond is not that women suddenly stopped ingesting enough calcium. It is that the production of the bone building ovarian hormones (i.e. testosterone, estradiol and progesterone) diminishes significantly during this time period, causing the rate of bone loss (osteoclastic activity) to exceed the rate of bone building (osteoblastic activity).

In addition to the loss of hormones, with advancing age there is usually a decrease in physical activity necessary to build bone. Despite the current recommendations, walking is just not enough. Bone, like muscle, grows in response to resistance training (weight training). Walking, though better than sitting on the couch, is not a sufficient enough stress on the bone to cause the osteoblasts to lay down new bone.

Adequate vitamin D is necessary for absorption of dietary calcium from the gut and in the formation of bone. Vitamin D is the most common deficiency I see in my practice. How much vitamin D should you take? Nobody can answer that without testing blood. I have seen patients on the golf course all day in sunny Southern California still significantly deficient in vitamin D ( we lose the ability to convert sunlight to vitamin D with age). One patient in particular golfed 6 days per week, was taking 21,000 units of vitamin D daily, and his blood tests showed he was still deficient!

Remember that taking supplemental calcium is not without risks. Many of you will remember the media hype about a medical report last summer suggesting that calcium supplementation may increase the risk of heart attacks. The report was from the British Medical Journal which reported on a survey of fifteen trials in which participants (all over age 40) were given at least 500 mg of elemental calcium per day. The researchers concluded that calcium supplements increase the risk of myocardial infarction by about 30% over five years.
(http://www.foxnews.com/health/2010/07/30/calcium-supplements)
I have read the full study and although there are some flaws in the study design, my belief is that the authors conclusion in theory is correct.

Remember that calcium is part of plaque, the hard material that builds up in the lining of our blood vessels. You may have heard of a test called a Coronary Calcium Score, which is a CAT scan test that detects the amount of plaque in the blood vessel walls. Where there is calcium, there is plaque. If there is too much calcium in the blood, it can stick to blood vessel walls.

Many patients do not understand that the calcium level detected in blood tests is NOT a reflection of the amount of calcium in the bone.
There is a very narrow range of calcium that the body needs in order to be healthy (approximately 8.5 to 10.2 depending on the lab). Ingesting a few thousand milligrams of calcium in a pill is too much to be taken up by the bones rapidly enough. The excess calcium will stick to tissues, including the lining of blood vessels, and contribute to plaque formation.

So how much extra calcium should one take? That is like asking what size shoe should one wear-it depends completely on the individual. In the active person with good vitamin D and hormone levels (as tested and followed with blood tests), the answer is none. You didn't need calcium supplementation in your 20's because you had optimal levels of bone building hormones, were likely more physically active, and still youthful enough to convert sunlight to vitamin D. Age should not be an excuse for not having everything necessary to build bone. As far as using drugs for bone loss, I never prescribe them. You don't develop a Fosamax deficiency, so why take drugs that have nothing to do with the normal, healthy bone buidling process, and can have serious side effects. www.fleurhealth.com