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Gallstones and heart disease risk

People who’ve suffered gallstones may have a slightly increased risk of developing heart disease down the road, a large new study suggests.
In a group of more than one-quarter million U.S. adults, researchers found those with a history of gallstones were 17 percent more likely to develop heart disease over the next few decades. 
Gallstones and heart disease share some of the same risk factors -- such as obesity, type 2 diabetes and unhealthy cholesterol levels. But those risk factors couldn’t completely explain away the finding, the researchers said.
To cardiologist Dr. Richard Stein, the study makes a “pretty convincing” case that gallstones, themselves, are a risk factor for heart disease.
Stein, who wasn’t involved in the research, is director of the urban community cardiology program at New York University School of Medicine.
He said that people with a history of gallstones may want to pay extra attention to their cardiovascular health.
“Eat a heart-healthy diet, exercise, keep your blood pressure down. It would be prudent to get your other heart disease risk factors under control,” said Stein, who is also a spokesperson for the American Heart Association.
Gallstones are hard particles that develop in the gallbladder -- a small organ that stores the bile fluids that help the body digest fat and fat-soluble vitamins.
Gallstones form when there are imbalances in the substances that make up bile: Excess cholesterol is the usual suspect, according to the U.S. National Institute ofDiabetes and Digestive and Kidney Diseases (NIDDK).
For many people, gallstones cause no symptoms, NIDDK says. But if they block a bile duct, they can cause abdominal pain -- often after a heavy meal. Most often, treatment involves surgically removing the gallbladder.
Some studies have suggested that people with a history of gallstones face a higher risk of heart disease. But these studies have had limitations, according to Dr. Lu Qi, the senior researcher on the new study. Qi is also a professor at Tulane University in New Orleans.
So Qi’s team combed through data from three large, long-running studies of U.S. health professionals.
In all, the studies followed more than 269,000 men and women for up to 30 years. Just over 6 percent of women and 3 percent of men said they’d ever been diagnosed with gallstones.
Among women, Qi’s team found, those with a history of gallstones were up to 33 percent more likely to eventually develop heart disease. For men, gallstones were linked to an 11 percent increased risk.
The researchers then pooled those results with findings from four previous studies that included nearly 900,000 people. All together, they found that adults with a history of gallstones were 23 percent more likely to develop heart disease​.
Although the study couldn’t prove a cause-and-effect relationship between gallstones and heart disease, Qi suggested that changes in the gut’s “microbiome”​ may play a role.
That refers to the trillions of bacteria and other microbes that normally dwell in the digestive​ system. Gallstones, Qi explained, can disrupt the balance of microbes in the gut, and recent studies have linked such disturbances to the risk of heart disease.
But, he stressed, that’s just a theoretical explanation for now.
Stein speculated on another possibility: Some cases of gallstone disease might spur low levels of inflammation in the body that feed the development of heart disease.
“We’ve known for years that chronic, low-grade inflammation is associated with heart disease,” Stein said.
Whatever the reasons for the link, Qi said it highlights a connection between the gastrointestinal and cardiovascular systems.
“To help protect your heart health, you may also need to protect your gastrointestinal system,” he said.
There are certain risk factors for gallstones that you cannot change, according to NIDDK. People with a family history of them are at increased risk, for instance. Gallstones are also more common in women than men.
But some other factors -- such as obesity, and diets high in fat and processed carbohydrates -- can be changed, the institute suggests.
The study was published online Aug. 18 in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

cholesterol smarts


Saturated fat is a bigger culprit than cholesterol in your diet. Meats, whole-fat dairy products, and other foods from animals can be loaded with it. It's also in some vegetable oils such as palm and coconut oil. But foods with cholesterol can also raise your cholesterol. So most people should cut cholesterol -- in foods such as organ meats, egg yolks, and whole milk -- to less than 300 mg a day.

Cheese has a lot of saturated fat. Just three slices of cheddar cheese, for example, has about 18 grams. That's more saturated fat than you should probably have in one day! In fact, cheese is the biggest source of saturated fat in the typical American diet. Choose low-fat or non-fat cheeses, or consider skipping cheese.

Before about age 50, men tend to have higher total cholesterol than women. But women's "bad" cholesterol tends to rise with menopause when the female hormone estrogen declines. After about age 50, women usually have higher cholesterol than men of the same age.

There are no specific symptoms of high cholesterol. To know if your cholesterol is too high, you have to have a blood test.

Although cholesterol levels generally rise with age, you don't have to be older to have high cholesterol. Even children can be at risk, especially if they have a family history of high cholesterol and heart disease. Everyone should start getting cholesterol tests at age 20, or earlier, according to the American Heart Association.

Cholesterol is waxy, fat-like material that your body needs to make hormones, vitamin D, and acids for digesting food. But your body makes all the cholesterol your body needs. You don't need to add to it in your diet.

HDL (high-density lipoprotein) cholesterol is actually the "good" cholesterol. An HDL level of 60 mg/dL (milligrams of cholesterol per deciliter of blood) or above helps lower the chance that you'll get heart disease.

Too much LDL (low-density lipoprotein) cholesterol raises your risk of heart disease. An LDL level of130 mg/dL or above is considered high. Excess LDL will contribute to the formation of thick, hard buildups, known as "plaque," on the walls of your arteries. Your arteries become narrower and harder, so less oxygen-rich blood can flow through. This is known as atherosclerosis, a leading cause of heart attacks and strokes.

Soluble fibers can lower blood cholesterol levels. Oatmeal is a good source of soluble fiber. So are beans and many fruits and vegetables. In studies, LDL cholesterol dropped 3%-5% in people who added five to 10 grams of soluble fiber a day to their diet. A bowl of oatmeal and a banana have about 2 grams of soluble fiber.

Eggs do have a lot of cholesterol. In fact, two scrambled eggs have more cholesterol than the total amount you should have in a day. But you should think about more than just the cholesterol grams in any food you're eating. For example, chocolate pie is loaded with calories and saturated fat, which can also increase cholesterol, so you wouldn't want to have a lot of it. Eggs may have cholesterol, but they're also a great source of protein and lots of other nutrients. The cholesterol is all in the yolk, so egg whites or yolk-free egg substitutes are a good alternative. If you're worried about your cholesterol levels, check with your doctor.

You need some fat in your diet. Fats supply energy and essential fatty acids, and they help absorb nutrients from the foods you eat. The trick is to eat the best kind of fats. When you can, replace animal fats with plant fats (like nuts, seeds, olive or canola oils), which can actually help lower cholesterol. Eat as little trans fats as possible, and cut saturated fat to less than 10% of your calories.

Exercise or other regular physical activity can help lower your "bad" LDL cholesterol and raise your "good" HDL cholesterol. Adults should get at least 30 minutes of moderate-intensity exercise on most days of the week. But any regular physical activity lowers your risk of high cholesterol and heart disease.

Shoot for a total cholesterol level of less than 200 mg/dl. A level of 200 to 239 mg/dL is considered "borderline high" and 240 mg/dL or more is high.
For LDL (bad cholesterol), anything under 100 mg/dL is best. Levels of HDL (good cholesterol) that are lower than 40 mg/dL raise men's chances of getting heart disease. HDL levels less than 50 mg/dL raise the chance of heart disease in women.

Statins are the best-known type of cholesterol-lowering medication. They can drop LDL cholesterol by 20% to 55%. Statins help the liver produce less cholesterol and boost its ability to remove LDL cholesterol already in the blood. They also help raise "good" HDL cholesterol.

Most people don't need drugs to lower their cholesterol. Diet, exercising, and losing weight can help do it. The TLC (Therapeutic Lifestyle Changes) program can guide you on the changes you should make, depending on your risk for heart disease. The main goals are to eat less saturated and trans fat and cholesterol, and get more physically active. If those things alone don't lower your levels, your doctor might suggest eating more soluble fiber, like beans and oatmeal, and adding plant stanols or sterols. The best sources for stanols and sterols are fortified foods, including margarine and orange juice. If you can't do that, you'll probably need to take medicine.


Do

I am only one, but still I am one. I cannot do everything, but still I can do something; and because I cannot do everything, I will not refuse to do something I can do. Edward Everett Hale

Exercise

You know you should do it. And you know why: Exercising -- simply put, moving instead of sitting -- is critical for safeguarding your health and setting a good example for your kids. So why does it seem so hard to get yourself moving?
The truth is: You can. But knowing how and why to exercise isn’t enough. You need to develop the right mind-set to get and stay motivated.
"Change is hard!" says certified health behavior coach Shelly Hoefs, fitness supervisor at the Mutch Women’s Center for Health Enrichment in Sioux Falls, S.D. "When we try to start exercising, we think of all the excuses for not doing it and all the things that have gotten in the way before. Getting fit starts to seem overwhelming. And that makes it feel stressful. Before long, we don’t want to do it anymore."
Here are five steps to get you moving in the right direction -- and keep you going.
1. Find Personal Motivation to Exercise
What you need to get you up off the couch is a reason that's important to you. At first, that may be some external factor, says Cal Hanson, director of the Sanford Wellness Center in Sioux Falls, S.D. It could be a number on the scale that surprises you or your doctor's recommendation that you need to move more to stay healthy.
There are all kinds of benefits to getting fit. Which matters most to you? Something as simple as taking a walk after dinner every night helps to:
Plus, by becoming active, you're being a good role model for your children.
These benefits may get you started, but they may not cut it when it comes to keeping you moving day after day, Hanson says. To keep up your motivation to exercise over time, you also need to find your internal motivators. Maybe taking a yoga class leaves you feeling more energized or less stressed. Maybe a run or walk every day helps you let go of stress. Hanson says these are the kind of rewards that are meaningful to you on a personal level and that can help keep you motivated.

2. Set Realistic Goals to Get Fit
CDC guidelines call for adults to do 2 1/2 hours of moderate-intensity aerobic exercise a week. That's a 30-minute walk five days a week. If you kick it up a notch -- jogging or running, for example – it can be 15 minutes a day, five days a week.
You can aim for these exercise guidelines, but don't try to meet them at the start. "People lose their motivation to exercise when they try to do too much too soon," says Hanson.
So instead of walking for 30 minutes a day right off the bat, start out doing 15 minutes a day, two or three days a week.
Set weekly goals, gradually adding more time and intensity. At the end of each week, take a look at how you did. If you reached your goal, celebrate! "And if you didn't reach your goal," Hanson says, "think about what went wrong and how you're going to respond differently next time."
3. Stop Thinking of It as Exercise -- Do Something You Enjoy
You don't have to go to the gym to get a good workout. It's all about moving more -- however you do it. For some people, going to the gym provides structure that helps them focus and a sense of accomplishment when they're done. For others, it's a chore -- one they wind up avoiding as often as they can.
What else can you do? Almost anything that gets you -- and your family -- moving:
  • Walk the dog, or walk a neighbor's dog. They'll be grateful for the help!
  • Have dance contests with the kids instead of watching TV.
  • Go to the park and play hide-and-seek.
  • Shoot hoops with the kids.
  • Walk or bike to the store instead of driving, or park far away from the entrance.
  • Get off the train a stop early and walk the rest of the way to your office.
If you think about it, you're surrounded by opportunities to get more active. Find the ones that you get excited about. You're more likely to keep doing them if you're having fun.


4. Plan How to Fit Exercise Into a Hectic Schedule
For busy parents, a major obstacle to getting fit is lack of time. If you wait for time to open up, chances are you won't be able to squeeze in a walk or a dance class very often. To avoid getting sidetracked by the daily demands of life, try these tips:
  • "Sit down with your schedule and really carve out blocks of time," says psychologistSusan Bartell, PsyD, author of Dr. Susan's Fit and Fun Family Action Plan. Put it in your calendar like any other appointment.
  • Add physical activity to things you already do. For example, pedal a stationary bike while reading or watching TV. Or take a walk with a friend to catch up instead of calling each other on the phone.
  • Plan activities you can do with your kids, such as going for bike rides or skating. Not only will you find more time for fitness, you'll help inspire your kids to move more.
If you plan ahead for potholes on the road to fitness, you're more likely to stay on course, Bartell says. "When you think through solutions to problems in advance, you're less likely to give up when a pothole comes along."
5. Bounce Back From Setbacks
You've set a reasonable fitness goal. You've prepared for potential problems. Yet somehow you still didn't make it to the gym today as you had planned. Don't let that be your downfall.
"For many people, this is a slippery slope," Hanson says. "It reminds them of times when they failed before, and they begin to think of themselves as exercise failures."
When this happens, it's time for an attitude adjustment so you don't completely lose your motivation to exercise. If you miss the gym on Monday, that doesn't mean your whole week is shot, Hanson says. It simply means you need to hit the gym on Tuesday or take the dog for an extra-long walk tonight.
Knowing how to exercise isn't just a matter of learning how to use your body to hold a yoga pose or swing a racquet. It also involves learning how to use your mind to propel yourself into action and stick with a fitness routine.

"Start thinking of yourself as someone who exercises," says Hoefs. "Eventually, that will become your identity

walking

You have to stay in shape. My grandmother, she started walking five miles a day when she was 60. She's 97 today and we don't know where the hell she is. Ellen DeGeneres