health

Checking for Added Sugars on Nutritional Labels Can Be Tricky

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | October 24th, 2017

Dear Doctor: I've read that "added sugars" should be limited to 10 percent of our total daily calories. But how are added sugars listed on nutritional labels? Are they part of the carbohydrates category? Does the sugar in a peach or a glass of milk count?

Dear Reader: Ah, nutrition labels. They're a wellspring of useful information and occasional confusion. But with a little decoding, you can use nutrition labels to set a course toward mindful and healthful eating.

Sugars are carbohydrates that are found in fruit and milk and, to a lesser extent, vegetables. They are either naturally occurring or are added to food during processing. Naturally occurring sugars are those that are present in a food, whether a banana, carrot, peach, glass of milk or spoonful of honey, exactly as harvested. Added sugars are those that are used in the cooking or processing of a food item to change its flavor.

One of the challenges to identifying added sugars is that they go by so many different names. A label that says sugar, brown sugar, raw sugar, molasses or honey is pretty easy. Move on to sugars like maltose or dextrose, and things are trickier.

One rule of thumb is that if a word ends in "ose," there's a good chance that sugar is involved. Fructose, glucose, high-fructose corn syrup, lactose and sucrose -- all these are sugars. One exception is sucralose, an artificial sweetener that goes by the name Splenda. A bit trickier are ingredients with the word "syrup," like cane syrup, agave syrup and corn syrup. And if you see something like "fruit concentrate," that's also an added sugar.

You're absolutely right that when it comes to added sugars, the federal Centers for Disease Control and Prevention (strongly) suggest that we keep them to less than 10 percent of our daily diet. That means someone who eats 2,000 calories per day should limit added sugars to less than 200 calories per day. Considering that each gram of sugar has 4 calories, that's still a hefty allowance for sweets.

So how do you track added sugars? First of all, naturally occurring sugars do not count toward the total. If you eat a fresh pear, even though it contains 17 grams of sugar, you have eaten zero grams of added sugars. Artificial sweeteners also do not factor in the added sugars count.

The challenge comes with existing nutritional labels, which don't plainly identify added sugars. The "sugars" or "carbohydrates" designation indicates both naturally occurring and added sugars. That means you have to do a bit of sleuthing. Read the list of ingredients for telltale sugars. The higher up they appear on an ingredients list, the greater percentage of added sugars the product contains. Check serving size -- remember 4 calories per gram of sugar -- and then guesstimate.

If you think this is a crummy way to track added sugars, we heartily agree. The good news is that the FDA has ordered a new nutritional label that clearly states the grams of added sugars. The bad news is that although the label was approved in 2016, it won't make its debut until July 2018.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Husband's Cholesterol Level Prompts Wife to Question Statin Need

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | October 23rd, 2017

Dear Doctor: At our last checkups, my husband's LDL was 147, and his HDL was 70. He doesn't know his total cholesterol. My LDL was 157, my HDL 77, and my total cholesterol was 254. But only my husband was prescribed a statin. Is there a reason for this, other than that we have different doctors?

Dear Reader: Although cholesterol is but one of a myriad of risk factors that lead to atherosclerosis, or hardening of the arteries, it's one that can be changed with medications -- with some experts believing that a large portion of the population should be taking these medications to prevent a heart attack or stroke. However, the science is somewhat nuanced as to who precisely might be the best candidates for cholesterol-lowering medication.

The question to ask: Does your husband have other risk factors for atherosclerosis that you don't? This may not be applicable to you or your husband, but smoking cigarettes is one of the greatest risk factors for heart disease. Women who smoke 20 cigarettes per day have a six-times-higher risk of having a heart attack than those who have never smoked. Men have a three-times-greater risk. Other independent risk factors for heart disease are: high blood pressure; diabetes; a history of early heart attacks among immediate family members; elevated levels of an inflammatory marker called cardiac CRP; age; obesity; kidney problems; and, of course, gender. Men simply have a greater incidence of heart attacks than women.

Now let's look at the numbers. Both you and your husband have a high HDL, the so-called "good" cholesterol. People with low HDL cholesterol (less than 40 in men and less than 50 in women) have a greater risk of heart attacks. Elevated LDL, the so-called "bad" cholesterol, is an independent risk factor for atherosclerosis. Studies have shown a decrease in heart attacks and strokes in those with risk factors for atherosclerosis who lower LDL cholesterol with medication.

Many doctors use a calculation based on age, HDL cholesterol, total cholesterol, diabetes, high blood pressure and smoking history to determine a 10-year risk of having a heart attack, stroke or heart failure. The assessment that these doctors make is this: If the calculation shows that a person has a greater than 7.5 to 10 percent risk over a 10-year period, then they should be on a medication to lower cholesterol. Your husband's risk, based on other factors, may have put him at a level for which treatment was deemed necessary.

That said, the science behind the risk calculator is not strong and is, in fact, based on older data. A recent study published in the Journal of the American College of Cardiology tracked 307,000 patients from 2008 through 2013 -- complete with a five-year follow-up -- and found, preliminarily, that the assessment calculators significantly overestimated risk. Thus, many patients may be placed on statins based on an inaccurate calculation.

To your point about physicians, however, some doctors are indeed more likely to treat an elevated LDL cholesterol than others.

So, while your husband may have other risk factors that would lead a physician to prescribe a statin, if you're still concerned about your cholesterol numbers, I would suggest you discuss this with your physician.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Some NSAIDs Linked to Greater Risk of Heart Attack and Stroke

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | October 21st, 2017

Dear Doctor: Do NSAIDs really increase the risk of heart attacks, as I read in the news recently? I take aspirin or Tylenol whenever I get a headache, which is at least a few times each month. Should I be worried?

Dear Reader: Nonsteroidal anti-inflammatory drugs, or NSAIDs, are a widely used group of medications taken to reduce or relieve mild to moderate pain. Ibuprofen, which sells under brand names like Advil and Motrin, and naproxen, which appears under brand names like Aleve and Naprosyn, are among the more popular NSAIDs. Others include diclofenac and celecoxib, both of which require a prescription. And to get right to your question, yes, a body of research warns that NSAIDs are associated with an increased risk of heart attack and stroke.

It's estimated that up to 30 million people in the United States turn to NSAIDs each day to deal with aches and pains, cramps, fever and swelling. The drugs work by blocking the enzymes that produce compounds known as prostaglandins, which trigger the inflammatory response that your body uses to heal itself. That inflammatory response is what causes the aches, pains, fever and swelling when we get hurt or fall ill.

However, NSAIDs can also act on platelet aggregation and cause blood clots, increase fluid retention, raise blood pressure and cause arteries to constrict. When this happens in the right combination and in the wrong person, it can lead to a heart attack or a stroke. Some of the more minor side effects associated with NSAIDs include stomach upset, nausea, diarrhea, rash and constipation.

In 2005, the Food and Drug Administration issued a warning about the link between NSAIDs and stroke and heart attack. A decade later, working from the results of additional research, the FDA strengthened that warning. Since then, numerous studies have come to the same conclusion.

Most recently, a study from the University of Montreal Hospital confirmed the link between NSAIDs and heart attack or stroke. Researchers found that after as little as one week of use of NSAIDs, heart attack risk increased between 20 and 50 percent. One month after the drug was stopped, that risk declined sharply.

While some NSAIDs require a prescription and are taken under a doctor's guidance, quite a few are available over-the-counter. That means that unless buyers are taking the time to read the small print on both the bottle and that origamilike paper insert in the package (and, really, how many of us actually do?) and then strictly following the dosage guidelines, they risk running into trouble.

As for whether you need to worry, the answer is no.

The aspirin you're taking is an NSAID, but the good news is that it is exempt from the stroke/heart attack warning. In fact, because aspirin inhibits the clotting of blood for periods of time ranging from four days to a week, it is commonly used to prevent heart attacks and strokes. Tylenol, the other popular over-the-counter pain reliever you're taking for headache pain, is not considered to be a NSAID. However, do be sure to read the label -- when it is not used properly, Tylenol can affect the liver.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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