Diabetes

Dr. Steven Reisman, a Cardiologist in New York City, Interviewed on Fox News about Obesity as a Disease.

July 16, 2013 by admin

Is obesity a disease

Dr. Steven Reisman, a New York City cardiologist, was recently interviewed on Fox Business News regarding the American Medical Association recently passing a resolution recognizing obesity as a disease. A disease, which is defined as an abnormal condition which interrupts normal bodily functions and is usually associated with symptoms and signs, may also include disorders and syndromes.

Obesity is generally defined as an elevated Body Mass Index (BMI). This is a formula utilizing both height and weight. A BMI over 30 is generally considered obese. One of the problems with using only the BMI is it may overestimate body fat in athletes and others with a muscular build, and may also underestimate body fat in older persons and those who have lost muscle mass. Another way of defining obesity is looking at “belly fat” by measuring the waist circumference. It is thought that a waist size greater than 35 inches for women and greater than 40 inches for men increases the risks that are associated with obesity and overweight individuals.

It is estimated that 1 in 3 Americans are obese. The complications of obesity include high cholesterol and elevated triglycerides, Type 2 Diabetes, high blood pressure or hypertension, metabolic syndrome, which is a combination of high blood sugar, high blood pressure, and high lipids, and also heart disease including heart attack and stroke. One study has shown that obesity can increase the risk of dying from heart attacks by 60% compared to non-obese individuals.

Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center, recommends early evaluation for obesity and also early evaluation for the complications of obesity including elevated blood sugar or type 2 Diabetes, high blood pressure, elevated lipids, and the possibility of risk for heart attack and stroke. This type of evaluation can be accomplished in a consultation with testing done at the New York Cardiac Diagnostic Center.

DR. STEVEN REISMAN, A CARDIOLOGIST IN NEW YORK CITY, DISCUSSES THE RELATIONSHIP BETWEEN PRE-DIABETES, TYPE 2 DIABETES AND METABOLIC SYNDROME

March 13, 2012 by admin

The prevalence of type 2 diabetes is increasing in the United States according to Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center and a cardiologist in New York City. Pre-diabetes is usually defined as an elevation of fasting or post-prandial glucose levels. The American Diabetes Association has defined impaired fasting glucose as a level of 100 to 125 mg/dl. Also, an elevation in hemoglobin A1c or glycosylated hemoglobin (HbA1c) at a level of 5.7% to 6.4% may also represent pre-diabetes.

Metabolic Syndrome is related to pre-diabetes. Metabolic Syndrome is defined as any three of the following five components. These components include an elevated glucose level, abdominal obesity, elevated blood pressure, elevated triglycerides, and reduced high-density lipoprotein (HDL) cholesterol. Most individuals with metabolic syndrome have abdominal obesity. It is felt that insulin resistance may be mediating the metabolic risk factors of the metabolic syndrome. Most people with metabolic syndrome have insulin-resistance. It should be noted that the prevalence of pre-diabetes and metabolic syndrome overlap but not exactly. One can consider the metabolic syndrome as a pre-diabetic state. When comparing individuals without metabolic syndrome, those with this syndrome have an approximate 5-fold increase in diabetes risk. Once pre-diabetes is combined with metabolic syndrome, the risk is increased even more for diabetes.

The major adverse outcomes in individuals with pre-diabetes are macrovascular disease and type 2 diabetes, the leading contributors to microvascular disease. Macrovascular disease occurs both before and after the onset of diabetes, whereas microvascular disease occurs predominately several years after becoming diabetic. Metabolic Syndrome is a risk factor for macrovascular disease. Initial management is lifestyle intervention including weight reduction in obese subjects, reduced intake of dietary saturated and trans-fatty acids, cholesterol, and sodium along with increased physical activity.

According to Dr. Steven Reisman the Director of the New York Cardiac Diagnostic Center and a cardiologist in New York City these initial steps of lifestyle intervention in first line management should be emphasized to this group of individuals along with a thorough assessment of cardiovascular risk.

DR. STEVEN REISMAN, A CARDIOLOGIST IN NEW YORK CITY, DISCUSSES THE EFFECT OF DIETARY PROTEIN AND CONTENT ON WEIGHT GAIN DURING OVEREATING

March 8, 2012 by admin

According to Dr. Steven Reisman, one of the best cardiologists in New York City and the Director of the New York Cardiac Diagnostic Center, obesity and overweight affect greater than 60% of the United States public. It is estimated that the United States government spends in excess of $200 billion per year on obesity associated conditions and diseases.

Obesity is the result of an accumulation of excess body fat. Obesity is not just excess body weight because overweight can occur from either muscle or fat deposition. Diet composition can affect the relationship between total body fat and body weight. Obesity related medical conditions may be associated with an accumulation of excess fat while increased muscle mass is beneficial because of its positive effect on metabolism.

There is a large body of scientific evidence that indicates that protein is the most satisfying of the macronutrients. High protein diets providing 25% of total energy compared to diets with low protein may lead to greater weight loss. Reduced total caloric intake with an increase in the intake of low-fat protein-rich foods may result in more successful weight loss in the long term secondary to the effects on resting energy expenditure.

It is possible that patients who exercise and eat adequate protein may build lean body mass more efficiently than those who are on a low protein diet. Because muscle weighs more than fat per unit of volume it is possible for patients to gain weight with muscle mass while reducing weight circumference and overall fat.

In addition to a healthy long term diet, it is important to increase the proportion of omega-3 fats, increase the intake of colorful fruits and vegetables, and limit the intake of refined carbohydrates from soft drinks, cookies, cakes, pastries, candies, and many processed foods with both hidden fat and sugar. In addition, physical activity is important along with behavioral interventions including self-monitoring stimulus control, stress reduction, and social support that may be helpful in weight loss.

Clinicians should consider evaluating a patient’s overall fatness rather than simply by measuring body weight or body mass index and concentrate on the potential complications of excessive fat accumulation. The goals for treatment of obesity should involve fat reduction rather than simply weight loss, along with a better understanding of nutrition.

Dr. Steven Reisman director of New York Cardiac Diagnostic Center, cardiology center in NYC and a leading cardiologist doctor in New York City advocates and promotes a healthy lifestyle in the prevention of heart disease and the reduction of obesity.

DR. STEVEN REISMAN, A NEW YORK CITY CARDIOLOGIST, DISCUSSES THE RELATIONSHIP BETWEEN DIABETES TYPE 2 AND HEART DISEASE

April 8, 2011 by admin

Type 2 diabetes is also known as adult-onset diabetes and is a chronic condition that affects the way your body metabolizes sugar or glucose. With type 2 diabetes one’s body is resistant to the effects of insulin or the body does not produce enough insulin to maintain a normal glucose level. Type 2 diabetes symptoms may develop slowly. Some of the symptoms include an increase in thirst, frequent urination, increased hunger, weight loss, fatigue, blurry vision, and slow healing sores. Importantly, this condition may be asymptomatic.

The risk factors for type 2 diabetes include being overweight which is a primary risk factor, inactivity, family history, and a condition known as pre-diabetes in which the blood sugar level is higher than normal but not high enough to be classified as type 2 diabetes. The most important complications of type 2 diabetes include an increase in risk for various cardiovascular disease entities such as coronary artery disease, heart attack, stroke, and narrowing of the arteries along with high blood pressure.

Type 2 diabetes can be diagnosed by a simple blood test. There are two commonly done tests: one is called the A1C test and the other one is a fasting blood sugar test. The American Diabetes Association recommends routine screening for type 2 diabetes after age 45 especially if one is overweight. Screening is also recommended for those under 45 who are overweight and if there is other heart disease or diabetes risk factors such as a family history of type 2 diabetes or an elevated blood pressure.

In a recent article, HealthDay (3/2/11, Gordon) describes the findings of the ACCORD Study. This study evaluated “intensive” glucose therapy compared to “standard” therapy in patients with type 2 diabetes and heart disease. This study found that intensive blood sugar control in a very aggressive manner does not benefit people with type 2 diabetes and heart disease and, in fact, may harm them. This study found that very aggressive attempts to control A1C may result in a decrease in the rate of heart attack but an increase in mortality. This study was published in the New English Journal of Medicine on March 3, 2011 and involved a large group of patients. One finding in this study appears to be that it is important to decrease blood glucose levels to the recommendation of below 7% A1C but possibly not below 6% A1C.

Initial treatment for type 2 diabetes includes blood glucose monitoring along with healthy eating and regular exercise. Healthy eating should emphasize plenty of fruits, vegetables, and whole grains. In addition, counting carbohydrates is important and this can be done with the help of a dietician. Aerobic exercise is important and one should aim for 30 minutes of vigorous aerobic exercise most days of the week. In addition, if one is overweight, losing excess pounds is part of the treatment regimen in type 2 diabetes. In some instances, diabetes medication may be necessary if this initial treatment program does not work.

Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center, advocates prevention of type 2 diabetes with emphasis on eating healthy foods, increasing physical activity and losing excess pounds. This can be done after an initial consultation to evaluate the individual’s blood sugar level and can also be done in conjunction with a registered dietician.

ONE IN THREE AMERICANS HAVE “PRE-DIABETES”.

March 9, 2011 by admin

Dr. Steven Reisman, leading cardiologist NYC, Director of the New York Cardiac Diagnostic Center, discusses the recent CDC report that approximately one in three American adults have the condition called pre- diabetes. Pre-diabetes is a condition with blood sugar levels that are higher than normal but not high enough to be diagnosed as diabetes. Individuals with pre-diabetes have a greater likelihood of developing type II diabetes along with heart disease and stroke.

In a recent report in HealthDay (1/26, Preidt) the CDC reported that approximately 26 million Americans have diabetes and about 79 million Americans have pre-diabetes. This is a significant increase over estimated levels of pre-diabetes in 2008. It is felt that the increasing rates of obesity are related to the rising rates of both diabetes and pre-diabetes. Those who develop diabetes are not able to use the insulin that their body produces properly and therefore the amount of blood sugar increases. High blood sugar can have adverse effects leading to heart disease, stroke, blindness, kidney disease, nerve problems, and other vascular diseases.

Anther reason that there appeared to be an increase in the finding of diabetes and pre-diabetes may have to do with a relatively new testing procedure called hemoglobin A1c which measures the level of blood sugar over a period of several months from a simple blood test.

Dr. Steven Reisman, a Cardiologist in Manhattan, advises that a simple blood test and consultation can determine whether an individual has either diabetes or pre-diabetes. If one of these conditions is found an aggressive regimen of weight reduction, exercise, and if necessary medication can be prescribed.

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Diabetes

Is obesity a disease