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How what you eat and drink changes various areas of your health

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Perhaps the type of diet drink you contemplate might be a glass of green vegetable juices with your next meal or a glass of clean, filtered water. Too many so-called commercial diet drinks may spell heart trouble for older women, says the largest study of its kind that looks at diet drinks and cardiovascular outcomes, mortality. It appears healthy postmenopausal women who drink two or more diet drinks a day may be more likely to have a heart attack, stroke or other cardiovascular problems, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session, according to a March 29, 2014 news release, "Too many diet drinks may spell heart trouble for older women." A few years ago in other research, a Harvard University study examined links between diet soda and heart disease. See, "Is there a link between diet soda and heart disease?"

In fact, compared to women who never or only rarely consume diet drinks, those who consumed two or more a day were 30 percent more likely to suffer a cardiovascular event and 50 percent more likely to die from related disease. Researchers analyzed diet drink intake and cardiovascular risk factors from 59,614 participants in the Women's Health Initiative Observational Study, making this the largest study to look at the relationship between diet drink consumption, cardiac events and death.

"Our findings are in line with and extend data from previous studies showing an association between diet drinks and metabolic syndrome," said Ankur Vyas, M.D., fellow, Cardiovascular Diseases, University of Iowa Hospitals and Clinics, and the lead investigator of the study, according to the March 29, 2014 news release, Too many diet drinks may spell heart trouble for older women. "We were interested in this research because there was a relative lack of data about diet drinks and cardiovascular outcomes and mortality."

Information on women's consumption of diet drinks was obtained through a questionnaire that asked them to report their diet drink consumption habits over the previous three months. This information was assessed at follow-up year three of the Women's Health Initiative Observational Study. Each drink was defined as the equivalent of a 12-ounce beverage and included both diet sodas and diet fruit drinks. For the purposes of the analysis, researchers divided the women into four consumption groups: two or more diet drinks a day, five to seven diet drinks per week, one to four diet drinks per week, and zero to three diet drinks per month.

After an average follow-up of 8.7 years, the primary outcome – a composite of incident coronary heart disease, congestive heart failure, heart attack, coronary revascularization procedure, ischemic stroke, peripheral arterial disease and cardiovascular death – occurred in 8.5 percent of the women consuming two or more diet drinks a day compared to 6.9 percent in the five-to-seven diet drinks per week group; 6.8 percent in the one-to-four drinks per week group; and 7.2 percent in the zero-to-three per month group

The association persisted even after researchers adjusted the data to account for demographic characteristics and other cardiovascular risk factors and comorbidities, including body mass index, smoking, hormone therapy use, physical activity, energy intake, salt intake, diabetes, hypertension, high cholesterol and sugar-sweetened beverage intake. Women who consumed two or more diet drinks a day were younger, more likely to be smokers, and had a higher prevalence of diabetes, hypertension and higher body mass index. But Vyas says the association between diet drinks and cardiovascular problems raises more questions than it answers, and should stimulate further research.

"We only found an association, so we can't say that diet drinks cause these problems," Vyas said, according to the news release. He added that there may be other factors about people who drink more diet drinks that could explain the connection.

"It's too soon to tell people to change their behavior based on this study; however, based on these and other findings we have a responsibility to do more research to see what is going on and further define the relationship, if one truly exists," he adds, according to the news release. "This could have major public health implications."

About one in five people in the U.S. consume diet drinks on a given day, according to data from the National Health and Nutrition Examination Survey (2009-2010). But Vyas cautions that this particular study only applies to postmenopausal women

The average age in the study was 62.8. To be included in this analysis, women had to have no history of cardiovascular disease and be alive 60 or more days from time of data collection. Previous studies have found artificially sweetened drinks to be associated with weight gain in adults and teens, and seem to increase the risk of metabolic syndrome, which makes both diabetes and heart disease more likely. Vyas said, according to the news release, that future research could include clinical studies, animal models and even molecular and pharmacologic analyses to begin to explain what, if any, direct role diet drinks play in heart health.

The ACC's Annual Scientific Session brings together cardiologists and cardiovascular specialists from around the world each year to share the newest discoveries in treatment and prevention. Follow @ACCMediaCenter and #ACC14 for the latest news from the meeting. You also may be interested in another study about celiac disease, according to a March 29, 2014 news release, "Celiac disease linked to increased risk of coronary artery disease."

Celiac disease linked to increased risk of coronary artery disease.

A new study adds to mounting evidence about the role systemic inflammation may play in heart health. People with celiac disease may have a near two-fold increased risk of coronary artery disease compared with the general population, according to research to be presented today at the American College of Cardiology's 63rd Annual Scientific Session.

The study, "Coronary Artery Disease Prevalence is Higher among Celiac Disease Patients," is being presented today, March 29, 2014 by R.D. Gajulapalli, M.D., clinical associate at the Cleveland Clinic and co-investigator of the study. The presentation takes place today at the American College of Cardiology's 63rd Annual Scientific Session.

The new study is the first to look at the association between celiac disease and coronary artery disease and adds to the evolving understanding of how systemic inflammation and autoimmune processes might influence cardiovascular disease development. Data also showed a slightly higher risk of stroke among people with celiac disease compared to controls. You may wish to check out the March 29, 2014Medical Daily news article, "Celiac Disease May Double Risk Of Coronary Heart Disease."

Celiac disease is a chronic inflammatory condition of the digestive system that can damage the small intestine, eventually interfering with the absorption of key nutrients.

People with celiac disease are unable to tolerate gluten – a protein found in food such as wheat, rye and barley. Gluten is thought to trigger an immune and inflammatory response in the gut. "People with celiac disease have some persistent low-grade inflammation in the gut that can spill immune mediators into the bloodstream, which can then accelerate the process of atherosclerosis and, in turn, coronary artery disease," said R.D. Gajulapalli, M.D., according to the March 29, 2014 news release, "Celiac disease linked to increased risk of coronary artery disease." Gajulapalli is a clinical associate at the Cleveland Clinic and co-investigator of the study. "Our findings reinforce the idea that chronic inflammation, whether it's from an infection or a disease, can have an adverse role in coronary artery disease and heart health in general."

Researchers obtained electronic health records of patients from 13 participating health care systems between January 1999 and September 2013. Out of a total of nearly 22.4 million patients, 24,530 were diagnosed with celiac disease. Patients without celiac disease served as controls. There was no difference in smoking status or diabetes rates between the two groups.

Those with celiac disease were slightly more likely to have high cholesterol, but less likely to have high blood pressure. Patients were age 18 and older. Traditional risk factors for coronary artery disease including sex, race, diabetes, high cholesterol, high blood pressure and smoking were checked between patients with celiac disease and controls to make sure they were comparable.

Researchers found a significantly higher prevalence of coronary artery disease among patients with celiac disease compared to the control population (9.5 percent compared to 5.6 percent, respectively). Data showed a similar trend among younger patients, those under age 65, with celiac disease compared to those without celiac disease (4.5 percent compared to 2.4 percent)

"This is an important study because it highlights a specific patient population who might be at higher risk for coronary artery disease, even in the absence of traditional cardiovascular risk factors," Gajulapalli said, according to the news release. "We were surprised by the strength of the association, especially in younger people. Patients and doctors should be aware of this association."

Celiac disease affects an estimated 1 in 133 Americans. But experts believe upwards of 80 percent of people with celiac disease are underdiagnosed or misdiagnosed with conditions such as lactose intolerance and irritable bowel syndrome. Previous research shows celiac disease has been on the rise and is four times more common now than it was 50 years ago.

The only treatment for celiac disease is adopting a gluten-free diet

Sales of gluten-free products reached $2.6 billion in 2010, and are expected to exceed more than $5 billion by 2015. Although gluten is mainly found in foods, it can also be in everyday products such as medicines, vitamins and lip balms. Celiac disease has been linked to arrhythmias (problems with the heart's rhythm) and possible heart failure.

"Whether patients with celiac disease will need more intense risk factor modification like in diabetic patients with coronary artery disease will need to be studied," Gajulapalli said, according to the news release. For now, he says people with this and other inflammatory diseases should maintain a healthy lifestyle and be aware of traditional cardiovascular risk factors including diabetes, high blood pressure and high cholesterol.

Larger studies are needed to confirm this association and to examine how the severity of celiac disease may play a role. Because so many people may have gluten sensitivities but do not have celiac disease, future research should investigate whether this larger population may also be at risk for coronary artery disease. Earlier studies have linked celiac disease with arrhythmias, which is what prompted researchers to conduct this study.

The ACC's Annual Scientific Session brings together cardiologists and cardiovascular specialists from around the world each year to share the newest discoveries in treatment and prevention. Follow @ACCMediaCenter and #ACC14 for the latest news from the meeting.

The American College of Cardiology is a nonprofit medical society comprised of 47,000 physicians, surgeons, nurses, physician assistants, pharmacists and practice managers. The College is dedicated to transforming cardiovascular care, improving heart health and advancing quality improvement, patient-centered care, payment innovation and professionalism.

The ACC also leads the formulation of important cardiovascular health policy, standards and guidelines. It bestows credentials upon cardiovascular specialists, provides professional education, supports and disseminates cardiovascular research, and operates national registries to measure and promote quality care. For more information, visit CardioSource.org.

And on another note, a different study explains why the number of babies you have (as a woman) may play a role in your future cardiovascular health. You may wish to check out the March 28, 2014 news release, "Number of babies mom has may play role in future cardiovascular health." According to one study, women who give birth to four or more children are much more likely to have evidence of plaque in their heart or thickening of their arteries -- early signs of cardiovascular disease -- compared with those having fewer pregnancies, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session.

Women who give birth to four or more children are much more likely to have evidence of plaque in their heart or thickening of their arteries – early signs of cardiovascular disease – compared with those having fewer pregnancies, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session

While earlier studies have shown an association between several aspects of pregnancy – physiological changes, complications, number of pregnancies – and future heart disease risk, many questions remain about how pregnancy might affect cardiovascular risk. To better understand the potential link, researchers at the University of Texas Southwestern Medical Center set out to determine whether the number of live births is associated with early signs of cardiovascular disease.

"This is not a recommendation for women to only have two or three children," said Monika Sanghavi, M.D. "Our findings add to the growing body of evidence that the changes associated with pregnancy may provide insight into a woman's future cardiovascular risk and deserves further attention," according to the March 28, 2014 news release, "Number of babies mom has may play role in future cardiovascular health." Sanghavi is chief cardiology fellow, University of Texas Southwestern Medical Center, and lead investigator of the study.

This is the first study to look at two markers of subclinical atherosclerosis – a gradual narrowing and hardening of the arteries that can eventually block blood flow and lead to stroke and heart attack

The study included 1,644 women from the Dallas Heart Study, a multiethnic population-based cohort, who had both self-reported information about the number of live births and relevant imaging study data available. The average age at the time of analysis was 45 years and slightly more than half of the women (55 percent) were African-American.

Coronary artery calcium (CAC) scores were measured using computed tomography imaging and aortic wall thickness (AWT) by magnetic resonance imaging to determine whether or not women had evidence of subclinical atherosclerosis in the heart and artery walls. CAC was positive if it was greater than 10 and AWT was abnormal if it was greater than the 75th percentile for age and gender. These tests were done as part of standard subject participation in the Dallas Heart Study.

Using women who had two or three live births as a reference, women who had given birth to four or more children had an approximately two-fold increased risk of having abnormal CAC or AWT. This association remained even after adjusting for socioeconomic status, education, race and factors known to heighten the risk of cardiovascular disease. Women who had more babies were more likely to be older, Hispanic, have high blood pressure, higher body mass index and lower socioeconomic status.

Curiously, women who had zero or just one live birth were also more likely to show evidence of subclinical atherosclerosis – revealing a U-shaped relationship

Authors say it is unclear why this might be the case. But Sanghavi and others speculate they may have captured some women in this group who have an underlying condition that prevents them from carrying a first or second pregnancy to term, which may also predispose them to cardiovascular disease or risk factors. For example, women with polycystic ovarian syndrome can have menstrual irregularities and trouble getting pregnant, but they may also have other health changes such as excess body weight, diabetes, high blood pressure or high cholesterol.

Pregnancy itself sparks a cascade of changes that can place more strain on a woman's cardiovascular system. For example, the volume of blood being pumped through the heart increases by 50 percent. In addition, other physiological and metabolic changes occur, for example, increased insulin resistance and higher cholesterol levels.

"Pregnancy has been called 'nature's stress test,' and for good reason," Sanghavi said, according to the news release. "It may also help identify women who are at increased risk [for heart disease], even though right now they may not have any risk factors."

Sanghavi said this study suggests that clinicians need to be more thorough in documenting pregnancy histories to take advantage of this window into a woman's cardiovascular system

This information can be used to better estimate future risk of heart disease and monitor certain patients more closely to try to prevent future heart disease. However, what this might mean in practice has yet to be determined. "The benefit of pregnancy is that it occurs relatively early in a woman's life and allows for early intervention for those at higher risk," she added, according to the news release. Women in the U.S. have an average of two to three children, according to U.S. Census reporting.

The authors emphasized the need for more research to both confirm this association and explore the biological underpinnings of these findings. The survey instrument that was used did not allow the authors to differentiate those women who had chosen not to become pregnant and those who were unable to become pregnant for other reasons. This would be an important distinction to make when trying to understand the increased risk in women with zero to one live births. (Should another study look at the artery health of celibate nuns who have not had a pregnancy and who retire at various ages, many times in good health at least until their mid-eighties?)

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