By Kristin Bundy
Reviewed by Nihar Desai, MD, MPH, Assistant Professor of Medicine (Cardiology), Yale School of Medicine, New Haven, Connecticut
- Angiotensin converting enzyme (ACE) plays a role in cardiovascular homeostasis and blood pressure regulation.
- A high-fat diet, independent of weight gain was shown to increase serum ACE concentrations.
- Homozygous carriers of the ACE rs4343 variant had higher levels of ACE concentrations at baseline than heterozygous carriers or homozygous noncarriers; after 6-weeks of a diet high in saturated fats, they also had higher blood pressure.
Cardiovascular homeostasis and blood pressure are regulated in part by angiotensin converting enzyme (ACE).1 Serum concentrations of ACE were once thought to remain relatively stable, but recent research has shown that ACE levels increase with weight gain and decrease with weight loss.1 In a study published in the Journal of the American Heart Association,1 investigators examined whether serum ACE concentrations fluctuate with one’s diet, independent of weight gain, and if genetic factors are involved.
Forty-six pairs of twins who were relatively young (mean age 31) and nonobese (mean BMI 23 kg/m2) were included in the study.1 Subjects were first directed to eat a low-fat diet for 6 weeks (LF: 55% carbohydrates, 30% fats, and 15% protein). During the following 6 weeks, they were directed to eat a diet high in saturated fats (HF: 40% carbohydrates, 45% fat, and 15% protein). The total calories consumed during each 6-week period were similar.
After 6 weeks of a high-fat diet, fasting serum ACE concentrations rose by 15%—a significant increase independent of weight gain.1 The researchers also found that ACE gene expression in adipose tissue significantly increased. Using a proxy for ACE insertion/deletion polymorphism, ACE rs4343, the study was stratified by carriers of the variant: homozygous (GG), heterozygous (AG), and homozygous noncarriers (AA). Those with GG had higher ACE concentrations at baseline, and after the high-fat diet, had higher systolic blood pressure and twice the increase in ACE concentration as compared with patients with AG and AA genotypes.
Lead author Rita Schüler, PhD, from the Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam?Rehbrücke (DIfE), Nuthetal, Germany, noted that “the identification of such a strong gene-diet interaction on blood pressure in rather young and healthy study participants” was the most surprising finding—one which could change the course of screening and treatment of CVD.
Dr. Schüler explained, “Determination of individuals‘ rs4343 genotype could be utilized for patients with hypertension or borderline hypertension. Carriers of the ACE rs4343 variant (GG-genotype) would be expected to benefit from avoiding diets high in total and saturated fat. Furthermore, it is conceivable that patients with borderline hypertension carrying the GG-genotype would profit from adherence to a diet with low to moderate fat content in the manner that they might no longer need any medication.”
Nutrigenetic markers, like ACE rs4343 genotypes, are not commonly used in clinical practice because it’s a relatively new field of study, noted Dr. Schüler. But that may soon change. The study authors said in a press release that, if their results are confirmed in larger studies, it’s possible that ACE rs4343 could be used as a biomarker for cardiovascular disease risk, similar to how LDL cholesterol is used now.2
So what can clinicians glean from what was published in this study? Dr. Schüler concluded, “Our results are important with respect to the elimination of the upper limits on dietary fat intake in the US dietary guidelines and show that a diet high in total and saturated fat is detrimental, at least for certain individuals, based on their genetic setting. Furthermore, our findings support the need for providing personalized dietary recommendations to assist in disease management and prevention.”
- Schüler R, Osterhoff MA, Frahnow T, et al. High-saturated-fat diet increases circulating angiotensin-converting enzyme, which is enhanced by the rs4343 polymorphism defining persons at risk of nutrient-dependent increases of blood pressure. J Am Heart Assoc. 2017;6:e004465. DOI: 10.1161/JAHA.116.004465.
Zucchini noodles are a lighter, low-carb noodle alternative that you will love with this tasty pea pesto!
Zucchini has a good amount of potassium folate, vitamin A, and the antioxidant vitamin C.
Peas are little powerhouses
of nutrition. Green peas are a very good source of vitamin K, manganese, dietary fiber, vitamin B1, copper, vitamin C, phosphorus and folate.
Feel refreshed and energized with these simple ingredients!
Dairy Free, Gluten Free, Vegetarian, Vegan
3 medium size zucchinis
1/2 cup frozen peas, thawed
1/2 cup baby spinach leaves
1 cup mint leaves
1/4 teaspoon sea salt
1/2 cup extra virgin olive oil
- Spiralize the zucchinis. If they are too long, cut into smaller strands.
- In your food processor mix the peas, spinach, mint leaves and sea salt, slowly adding the extra virgin olive oil.
- Taste and add more salt according to your liking.
- Toss spiralized zucchinis with pea pesto.
Can Dropping Some Weight Save Your Knees? Loss was tied to less joint degeneration in study, but skeptics remain
Obese and overweight people who lost 5 percent or more of their weight over four years saw less degeneration of their knee cartilage compared with people whose weight stayed stable.
“Our study shows that a lifestyle intervention such as weight loss can slow the process of knee joint degeneration in patients at risk for and with osteoarthritis,” said lead researcher Dr. Alexandra Gersing.
“Therefore, it may slow the worsening of symptoms, such as pain and disability,” said Gersing, who’s with the University of California, San Francisco’s department of radiology and biomedical imaging.
“Osteoarthritis is one of the major causes of disability worldwide,” she said.
More than half of U.S. adults age 75 and older have osteoarthritis — the wear-and-tear form of the joint disease in which cartilage thins and wears away. And more than one-third of Americans over 20 are obese, the study authors noted.
Excess weight puts a strain on the knees that can result in arthritis and, potentially, the need for joint replacement, the authors said.
In addition, overweight people often alter their gait, which can affect the knee joint. They may also have higher blood levels of proteins that cause inflammation in the joints, increasing the risk for osteoarthritis, Gersing said.
For the study, Gersing and her colleagues collected data on 640 obese and overweight people who had mild osteoarthritis or were at risk of it. The patients, average age 69, were part of the Osteoarthritis Initiative, a nationwide U.S. study on the prevention and treatment of knee arthritis.
The participants were put into three groups: those who lost more than 10 percent of their body weight, those who lost 5 to 10 percent of their body weight, and those whose weight remained stable.
Over 48 months, the researchers found that patients with 5 percent weight loss had lower rates of cartilage degeneration than patients whose weight remained stable. Among patients who lost 10 percent of their body weight, cartilage degeneration slowed even more.
Weight loss also slowed degeneration of the menisci, the crescent-shaped cartilage pads that protect and cushion the knee joint, Gersing said.
“Weight loss seems to be protective for the knee joint,” she said.
Not everyone agrees the issue is that clear-cut, however.
Dr. Matthew Hepinstall, a New York City orthopedic surgeon, said although it’s likely losing weight slows osteoarthritis, it still hasn’t been proven.
“Weight loss is considered an important part of osteoarthritis management in patients who are overweight,” said Hepinstall, who’s with Lenox Hill Hospital’s Center for Joint Preservation and Reconstruction.
But, thin patients also experience worsening of arthritis, so losing weight isn’t the answer for all patients, he said.
This study should be interpreted with an important caveat, Hepinstall added.
Correlation does not prove causation. Without studies randomly comparing patients with weight loss to those with no weight loss, it’s impossible to conclude that weight loss definitely slows progression of arthritis, he said.
“It is possible that progression of knee arthritis caused pain that interfered with weight loss in some patients, while absence of progression allowed greater comfort in other patients, facilitating weight loss,” Hepinstall said.
The report was published online May 2 in the journal Radiology.
SOURCES: Alexandra Gersing, M.D., department of radiology and biomedical imaging, University of California, San Francisco; Matthew Hepinstall, M.D., orthopedic surgeon, Lenox Hill Hospital Center for Joint Preservation and Reconstruction, New York City; May 2, 2017, Radiology, online
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News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services.
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There are a variety of cognitive behavioral therapy techniques to encourage behavior chane especially when it comes to weight loss. One such technique is called motivational interviewing (MI) which is a self management support method. It is a method that has been scientifically shown to increase motivation and commitment for sustained behavior change and adherence to treatment.
Do you have clients who overthink making changes, or always find a way to avoid committing to a goal? Using motivational interviewing techniques in your practice may be helpful in these cases.
This conversational style of communication helps clients to verbalize their thoughts and barriers they might perceive that prevent them from making a change, set their own goals and then verbalize their own commitment plans. This method is rooted in neurolinguistics programming, helping clients to make a switch to positive thinking through eliciting change talk, affirmations, reflective listening and summarizing discussions.
MI has been used in various clinical settings for managing chronic diseases, and recent evidence has demonstrated that it can lead to effective behavior change after just one session. The goal as the practitioner is to refrain from judgement, proved support and nudge clients to create and verbalize their ideal health goals.
Examples of questions to ask include;
“How can I help you get through some of the barriers you are experiencing”
“How would you like to see your life 3 years from now?”
“What will happen if you don’t change?”
“What makes you think that it is time for a change?”
“What is the best thing that will happen if you change?”
MI can be particularly in weight management where several attempts at sticking with a weight loss program is a common occurance. MI can be useful to assess motivation and readiness to change as a reminder for clients on why they are making lifestyle changes as well as affirming that the road ahead may not always be obstacle-free. Your role as a practitioner is then to use right resources and information at the right time for the client.
You may already have your own style of providing counselling to clients, however adopting a new technique which is backed by strong scientific evidence, can move your clients from inaction to action in a shorter period of time with better health outcomes in turn.
When it comes to DNA testing, MI can be a good time to elicit why clients feel they need a test or why they would benefit. This is a great time to manage expectations as the test is part of a long-term intervention, not a quick fix. We hope you’ll give MI a try and see how your clients respond!
The GenoVive Team
Unfortunately, we currently live in an obesogenic environment where food is available all the time and in copious amounts. We don’t even need to leave the house to get a hold of food! Let alone burning it all off through exercise.
- Smart shopping apps: There are plenty of apps created by retailers which make use of big data to help you choose wiser. Whether you have allergies, intolerances or a health goal, these apps can steer you in the right direction and make it easier to choose between products which are not just based on the nice-looking packaging. This can include suitable foods to lose weight, reduce salt intake or just to improve your general health.
- Nutrition coaching apps: if you think you are eating healthy but are not quite sure, why not get a little help along the way? By snapping pictures of your meals and getting instant advice from an expert nutrition coach can go a long way in making sure that you personalize your diet according to your preferences and goals. In addition, they can help you with meals and snack ideas to make sure you don’t eat too much of the healthy food.
- Cognitive behavioral therapy: It takes a few times before a new habit sticks, therefore you may need a few reminders to make sure you stick to those new years’ resolutions. Whether it’s an image of a fresh fruit reminding you to eat a piece of fruit for you late-afternoon snack, or your phone vibrating to remind you to move around a little. New programs are available that help you to stay motivated and focused.
- Health tracking devices: With a new device being launched on a nearly monthly basis, there is certainly no lack of choice. We don’t need them all for sure, but to start off a healthy routine and to measure how active you really are, a tracking device can be indispensable to provide insight. You’d be very surprised how little activity you actually do by just sitting at your desk when the recommendation is to get up to 10,000 steps per day. I dare you to give it a try! Even the use of smart wearable devices are set to increase dramatically, meaning that important data is being collected about you without you needing to think about it or logging it.
- Smart cooking appliances: New technologies have allowed the creation of new cookware that can help in reducing the amount of fat that is used in cooking, ensuring that vegetables don’t get overcooked and even tells you when you are overcooking the risotto. If you’re not a comfortable cook and need some guidance, an app can tell you exactly what to do and provide some healthy recipes too!
- DNA testing: Looking at which genetic variants you have inherited is without a doubt the latest in using genomic technologies to promote health and tailor interventions. As the science is rapidly evolving, the ability to eat the right foods according to your unique genetic profile has become closer. With insight and knowledge of specific genetic variants and their role within the body, it is possible to tailor your diet to optimize health and reduce weight.
New technologies such as remote controls and cell phones have certainly made our lives easier, but we should not take this for granted. We now have to work harder to ensure we stay active mentally and physically and also use the app to simplify the vast amount of advertising and marketing messages we are exposed to on a daily basis to make the right food choices. Find the technologies that match your need and your health goals and your life may just vastly improve!
The GenoVive team