Archive for the ‘Healthy eating’ Category

Heart attacks Part 2: Prevention: risk factors & our kids

Wednesday, May 23rd, 2012

Here's a risk factor you can eliminate

This post pings off the April 17, 2012 article in The Wall Street Journal, “The Guide to Beating a Heart Attack.” I initially wrote about surviving a heart attack (myocardial infarction {MI} is the medical term). Next I wanted to turn toward the prevention side.

I first found the Interheart study’s article from 2004, “Nine modifiable risk factors predict 90% of acute MI.” The study followed 29,000 people from 262 sites in 52 countries and concluded that the common belief that half of heart attacks can be predicted was clearly an underestimate.

The research group found the same impact of the nine variables everywhere in the world: abnormal blood lipids (fats, like cholesterol) and smoking were at the top of their list. Then came diabetes, high blood pressure, abdominal obesity, stress & depression, exercise, diet and alcohol intake.

I was used to measuring cholesterol and its HDL (so-called good cholesterol)  and LDL (bad cholesterol) components. This study actually used a more sophisticated lipid approach.

They measured the ratios of  the proteins that bind to and carry fats, apolipoproteins A and B. APOA is associated with HDL lipids while APOB is said to unlock the door to cells and in doing so acts as an unwelcome delivery van for cholesterol. When present in high levels, APOB can lead to plaque formation in blood vessels and an increased risk of coronary heart disease (CHD).

They also found some good news: as expected, eating fruits and vegetables daily, exercising and perhaps moderate alcohol intake were associated with lower risks of CHD. Again this was true everywhere in the world.

The WSJ article mentioned that hospital admissions for heart attacks had actually decreased among the elderly; these nine factors were better predictors in younger groups. What can be done to stop the looming specter of CHD among our younger population?

The CDC examined the parameters in a recent online article titled “A Growing Problem.” One issue was “screen time.” Our kids eight to eighteen average four an a half hours a day watching TV and three more on cell phones, movies, computers and video games. I even read an article about a two-year-old whose parents think learns a lot from their iPad. Maybe so, but how much exercise does that kid (and his older compatriots) get?

The CDC feels there is a dearth of quality physical activity in our schools; as of 2009 only a third of them provided daily PE for our kids. And after they leave school or when they’re on vacation, many don’t have safe access to biking, hiking, running, playing areas and trails.

Somerville chose healthier food in their schools

One Massachusetts community, Somerville, has gotten attention for their anti-obesity integrated program, “Shape Up Sommerville”  (You can watch the thirteen minute PBS special on their community-wide progress). The Robert Wood Johnson Foundation is attempting to help similar programs get started across the country, especially focusing on childhood obesity.

Recently I heard a NPR comment that caught my attention. If we don’t do something to stop the epidemic of childhood obesity, we’ll soon be seeing CHD rates soar in people in their 20s and 30s and maybe even younger.

A French researcher said, “Mankind is doing a good job of killing himself.”

We need to try new approaches to help our kids. The Somerville plan sound like a good place to start.

 

 

 

Chocolate: a new medicine? Part One

Tuesday, March 27th, 2012

Dark chocolate, in small amounts, is good for youI was reading The Wall Street Journal this morning and came across an article titled “A Chocolate a Day to Get Slimmer?” I’m not a major chocolate eater, but had heard something on NPR about this study yesterday, so ate eight small pieces of dark chocolate at a board meeting last evening. Then, when I weighed myself before breakfast today, I realized I was down 2.8 pounds.

Should I continue this increased chocolate consumption or was that, as I of course knew, just “water weight” I’d lost? The previous night I’d eaten a prolonged meal with friends at our favorite Thai restaurant and the next morning had gained over three pounds.

Let me digress a bit. Whenever I mention water weight I’m really referring to fluid that the body keeps because of dietary salt excess. I normally don’t use table salt, as I have a family history of high blood pressure and was aware that most of us, eating a typical American diet, were ingesting far too much sodium, the crucial element in table salt. When I eat out I expect my weight to bounce up a few pounds and don’t worry about that short-term increase. The salt in the food causes me to retain fluid and therefore to gain weight temporarily. Many diet plans that advertise losing five or more pounds in the first week are really helping people get rid of water weight.

Okay, back to chocolate. The article I mentioned is important, but the message it’s carrying is nothing new. In 1973 I saw Woody Allen’s movie, “Sleeper” in which he plays a nerdish store owner who is revived out of cryostasis (a form of preservation using ultra-cold temperatures) after 200 years. In that future world science has shown chocolate to be good for you.

Two prominent food gurus, Andrew Weil and Den Ornish, mention health benefits of chocolate. I found Dr. Ornish’s 2007 Newsweek article,”Chocolate to Live For,” in which he mentions a host of medical studies showing dark chocolate, which has higher amounts of beneficial chemicals called flavinoids, may lower blood pressure and and improve blood flow to your brain and heart. White chocolate and milk chocolate have very small amounts of flavinoids and bitter dark chocolate has the most.

Eat a small bite of dark chocolate and meditate

The phrase “moderation in all things” dates back more than two thousand years to a Roman “comic dramatist.” It certainly applies here. None of the articles I read were about eating a lot of extra calories in the form of chocolate. Dr. Ornish’s approach made sense to me; he very slowly eats a bite of dark chocolate, meditates while doing so by focusing on the experience with all of his senses, and regards the very first bite as being the most pleasurable.

What a great way to eat something he regards as a special treat as well as a health food.

I’ve never tried that with chocolate, but having read his magazine piece, I’ll try that approach.

I’ll continue with more medical background on chocolate in my next post, but to whet your appetite will give you a link to today’s article in WSJ.

Happy chocolating.

 

 

 

The very high-priced spread

Saturday, February 4th, 2012

This obese teenager could be headed for trouble

I’ve been concerned about our burgeoning problem of excessive weight, so when the Journal of the American Medical Association for February 1, 2012 arrived, I was intrigued by the variety of articles touching on the subject. Let me start with a disclaimer: I have no clear-cut special competence, no magic bullet for preventing or treating obesity in our children. I do think it’s a major threat to the upcoming generations here and elsewhere in the world. I am also very aware that its opposite numbers, hunger and even starvation, threaten whole populations around the globe.

But my own background, both as a physician and as someone who has successfully fought weight issues (I weighed 218 in 1969 and 148 this morning), has made me concentrate on the American epidemic of eating to excess as a major area of my interest.

The first article dealt with kids and adolescents. A group of CDC researchers reported an update on obesity in American kids, giving data from 199 to 2010. The newest statistics show nearly ten percent of our infants and toddlers are obese and close to 17% of our kids ages two to nineteen. As the kids got older, more boys than girls were obese in this survey with over 4,000 participants.

Then there was an article titled “Weight Loss Stratagies for Adolescents,” based on a Boston Children’s Hospital Conference roughly a year ago. The MD, PhD Harvard Professor of pediatrics who discussed the issue began with the case history of a particular obese girl, a fourteen-year-old who was five foot six and weighed nearly 250 pounds (giving her a body mass index,BMI, of 40). Her adoptive parents were overweight themselves, but had to learn to “back off” in their attempts to control her diet. There is some early data that suggests that parents can help by providing health food choices in the home and facilitating enjoyable physical activity throughout the day (versus a fixed “exercise time).

I had seen an example of that with some former neighbors whose boys, in order to have their one hour of “screen time,” had to be outside playing for several hours at a time. Both youngsters were lean.

One critical point to be made is avoiding focusing on obese kids only. A large Danish study, published in the New England Journal of Medicine in December, 2007,  followed over a quarter million children born in the 1930 to 1976 time period. Denmark established a national civil register of “vital statistics” in 1968 and enrolled everyone in the country, giving them a unique number, ironically termed their CPR number. Although that had nothing to do, I gather, with cardiopulmonary resuscitation, which is what I think CPR means, the study did look at risk factors for coronary heart disease.

When your heart's on fire, it may not be from love

The results are impressive and threatening: every one point increase in BMI across the spectrum was associated with an increased risk of coronary artery disease. A child didn’t have to be fat to be at risk later on. One calculation estimated that a 13-year-old boy weighing 25 pounds more than the average had a one-third increase in the likelihood of having a heart attack before the age of sixty.

It’s time to start helping our kids live leaner and longer, healthier lives.

 

What sweetener do you use: Part 5; Fructose effects

Saturday, January 28th, 2012

A good place to start researching

I basically knew what happens when we ingest glucose, (eating it or drinking it depending on whether it’s in solid or liquid form, e.g frosting versus sweetened tea) : it goes through the liver and heads off to muscle and other body parts where insulin activity is responsible for energy use. But I wanted to compare its effects to those of fructose. First I found an old article (1986 vintage) in the American Journal of Physiology (AJP), hardly a bedside reading item for me these days, but one I used to proofread for as a research fellow. That, once I translated it into English that I could understand, changed my mind a bit.

Glucose does lead to an increase in insulin levels and an increase in carbohydrate breakdown, while lipid (fat) breakdown slows down. The net result is a considerable bump in energy use. ‘So far, so good,’ I thought. But a comparable amount of fructose resulted in a much smaller increase of insulin, yet considerably more carb breakdown and even less fat breakdown. So even more energy was used. That I hadn’t expected, but this study was a one-time experiment with seventeen healthy folk followed for a few hours.

So my next question, and I thought this one was far more important, was what happen longterm?

Let’s look at animal research first. A group from Princeton published an article online in a journal called Pharmacology, Biochemistry and Behavior in February 2010. Tha basic conclusion from these scientists contradicted what I had read elsewhere, but made sense. They concluded all sweetener calories are not equal– after feeding rats standard foods and adding either table sugar-sweetened water or HFCS-sweetened water. Even if the HFCS water was less sweet overall, the rats gained more weight. Long-term feeding experiments showed rats fed HFCS developed many of the signs of the “metabolic syndrome.” weight gain, fat deposition in the belly and abnormal blood levels of trigclycerides.

So fructose was being metabolized to form fat, while glucose was being used as it normally is. That brought their thoughts back to why fructose in HFCS is different from that in table sugar. According to this research group, HFCS contains free, unbound fructose while that found in table sugar is always tied to a glucose molecule. Their concept is that table sugar fructose has to go through an additional chemical process, freeing it from glucose, before it can be used by the body.

So why should we care what makes rats fatter?

But here's our real target

I found a long article in The Journal of Clinical Investigation (JCI), the other research magazine my boss (and I) reviewed potential articles for in 1970 to 1972. Here people who who overweight or obese to begin with were fed either glucose- or fructose-containing liquids for ten weeks.

And the results were similar. Those getting fructose had more belly fat develop. I think translates to more chance of heart disease  and other long term complications.

The evidence is gradually adding up; I think HFCS is something to be avoided. Let’s feed our kids and ourselves more fruits and vegetables and less processed foods.

What sweeteners do you use? Part 4: HFCS and mercury

Tuesday, January 24th, 2012

A safer place for mercury

In my last post I mentioned that fructose metabolism appears to be more complex than I learned in medical school. Of course that was in 1962-1966 and a lot has changed in medical knowledge in the forty-five plus years since then. We all know that fructose, in the form of high-fructose corn syrup (HFCS) is added to many processed foods and sweetened drinks; the question being debated is, “Is that bad for us?”

I’ve been reading a variety of articles from the medical literature and some popular websites on the subject and not all scientists, physicians and dietitians agree on the answer. I previously mentioned a Mayo Clinic online article that stresses the need to cut our added-sugar intake, both table sugar and HFCS, and mentions that research on HFCS isn’t yet at the point to implicate it as worse for you than other added sweeteners.

There’s also an article by Jennifer Goldstein from Prevention magazine that I found on the msnbc website. I’m not sure of her science background (she’s now the Beauty Director for the magazine). Nonetheless, her article is reasonably well-balanced, if you read between the lines. The over-all conclusion is that anti-HFCS evidence is slim. She quotes an NYC-based nutritionist as saying the calories in HFCS and table sugar, gram for gram, are equal, but mentions several reports that have shown HFCS samples may contain mercury… in small amounts.

But you don't want it here, or in your food

Mercury is a neurotoxin, a substance which can damage the brain, especially the developing brain of a fetus or infant. Even “small amounts” are considered dangerous for babies in the womb. We have all heard of its presence in fish, but mercury in HFCS was new to me. I’m about three years behind, it appears. I found a Washington Post article from January, 2009 which mentioned two studies examining this issue.

At that time, in spite of industry denials, nearly half of HFCS samples tested contained mercury as did almost a third of processed food and beverage products. The researchers writing on this  enormously significant problem noted that HFCS had been made using chemicals produced in industrial plants clinging to an outmoded, 19th century method

A now-retired FDA scientist, Renee Dufault, headed a study in 2009 showing low levels of mercury in all the processed foods she and colleagues tested (and none in organic foods) and then had their results verified by two independent labs. She then says the FDA’s head of their Food Additives section told her to quit her HFCS studies. She quit the FDA instead and published her results. A physician-headed team at the Institute for Agriculture and Trade Policy, a non-profit watchdog, repeated her studies using commercial beverages and foods. Their twenty-plus-page paper is worth reading.

By the middle of December, 2010, the HFCS industry had gotten the message. But until all HFCS made in the United States is mercury-free I’m going to avoid it.

What sweeteners do you use: Part 3. Fructose & HFCS

Friday, January 20th, 2012

It's time to dissect out the science behind sugars

I knew that sugars are found naturally in milk, fruits, vegetables and honey. MedlinePlus, from the NIH’s National Library of Medicine has a brief discussion of those natural sugars. I also knew that glucose was absorbed in the small intestine and leads to the pancreas putting out insulin. It’s eventually converted to energy, though some may be stored in another form in the liver and muscles until needed.

But before I get to the artificial sweeteners, I needed to read more about fructose, the other half of table sugar.  My first source, a Mayo Clinic article, didn’t make it to be much of a villain, but then I started to put the whole picture together. To start with, table sugar is half glucose and half fructose. The two “simple sugars,” called monosaccharides by chemists, have the same chemical formula with six carbon atoms, twelve hydrogens and six oxygens, but the way those are arranged is quite different. They each supply four Kilocalories per gram or fifteen per teaspoonful (That’s technically correct, but most of us just use the term “calories.”).

If you taste table sugar and call it a “one” in terms of how sweet it is, glucose is about three-fourths as sweet and fructose is nearly one and three-fourths as sweet.  Both are considerably sweeter than lactose, the kind of sugar found in milk. Fructose is also easier to dissolve in water and hangs on to water better; that’s apparently how it can lengthen the shelf life of baked goods.

That’s not why I think high-fructose corn syrup (HFCS) became ever-present in sodas, other sweetened beverages and processed goods. In a blog post I wrote many  months ago, I mentioned that after WWII our government wanted to find a way to use two kinds of war-time chemicals; they eventually became pesticides and fertilizers. Corn turned out to be an extremely efficient plant in turning sunlight to stored energy, so it was subsidized. Eventually that led to “monoculture, huge farms raising nothing but corn.

What's the motive: health or profit?

Like any other industry, the corn producers needed to make a profit and have their stock prices increase. That resulted in HFCS being produced and added to lots and lots of food and beverage items.

So what? A 2208 article in Science Daily gave me a clue. The way our bodies handle fructose is considerably more complex than that of glucose. The two simple sugars are separated from each other in the small bowel and glucose quickly passes through the liver on its way to all the other spots in the body where it can become energy. Fructose, according to scientists, makes the liver work harder and there’s some data pointing toward its triggering the production of fat.

And we don’t just get straight fructose in our diets: HFCS, according to the USDA, is about one fourth water and the rest dissolved sugars. HFCS42  (with 42% fructose) is added to many products, especially processed foods. HFCS55 (with 55% fructose) is added to soft drinks. It’s roughly comparable in sweetness to table sugar; the issue is why do you need to ingest any more sugar?

There’s been more research in this area and I’ll cover that in my next post.

 

 

 

Early cholesterol testing now recommended

Saturday, November 12th, 2011

We're seeing more obese kids

With our sweeping epidemic of childhood obesity ( current estimates say over one-sixth of American kids are obese, three times the prevalence rate seen thirty years ago), it’s time to take some additional steps. On Friday 11, 2011, sweeping new guidelines for childhood lipid testing were espoused by both the NIH’s Nation Heart Lung and Blood Institute and The American Academy of Pediatrics. I found these, of all places, not on the websites of the two august bodies, but on the front page of the Wall Street Journal, an NPR article and in the Los Angeles Times.

The actual article in the journal Pediatrics, won’t be out for two more days and should find a fair amount of opposition. Previous position papers by the AAP and the US Preventive Services Task Force have either suggested lipid studies be done in focused groups (eg. family history of heart disease or lipid disorders) or, if universally, no earlier than age 20. The CDC (actually the acronym has changed since it’s now the Centers for Disease Control and Prevention), in a 2010 report, commented that a single elevated LDL cholesterol reading in a child may be found to be normal in subsequent testing.

The current recommendation panel, headed by Dr. Stephen R. Daniels, an MD, PhD who is Chairman of Pediatrics at the University of Colorado School of Medicine, is quick to avoid any suggestion of widespread statin use for children found to have high levels of “bad cholesterol,” LDLs over 190 milligrams per deciliter. Another panel member, Dr. Elaine M. Urbana, director of preventive cardiology at the Cincinnati Children’s Hospital Medical Center, was quoted as saying, “This documents on the fact that this generation may be the first to have a shorter life expectancy than their parents.”

So go back to the facts: one-third of US kids are overweight and about 12.5 million of them are actually obese. Even here in Colorado, the thinnest state in the nation, I see some of those kids every day. We’re not just talking about high schoolers; some of these fat kids are as young as two.

What’s missing is a balanced diet with emphasis on fruits and vegetables and a reasonable amount of daily exercise.

earlier blood tests may let them live longer

Daniels comments, “…the atherosclerosis process really begins early in life.” he also said, “Heart disease is the number one killer in our society…people who are able to maintain a low risk through childhood and early adulthood have a lower risk (of dying from coronary artery disease).”

From my perspective, it’s our responsibility as parents and grandparents, to help prevent childhood obesity, the accompanying risk of later type 2 diabetes and the huge risk of early heart disease. I filled out a health history form yesterday and noted my mother had a heart attack at age 74 (she lived ’till 90), but ignored my father’s need for an artery unclogging procedure shortly before his 90th birthday. That may be something I can put off by eating well and exercising, but that’s not the focus here.

I never want to see a child or grandchild die of a heart attack in their 50s or 40s or 30s or 20s.

So blood tests between ages 9 and 11 and again between 17 and 21 make sense.

 

 

The Five-Second Rule revisited

Friday, October 21st, 2011

don't wind up here, or worse

When I was a kid, we often used the Five-Second Rule, that meant food falling on a relative clean surface could be eaten if it was picked up in less than that amount of time. In recent years I’ve heard jokes about this rule: when parents have their first child, they use five seconds as a safe time, with the second, it’s ten seconds and with later children, it’s wipe off the mud and let them eat whatever dropped.

I received the November issue of the Center for Science in the Public Interest’s Nutrition Action Healthletter several days ago  and noticed this month’s focus was “Safe at Home: How to keep your kitchen from making you sick.” I haven’t had time to read much of the issue, but leafed through it and saw a brief blurb titled “Ignore the five-second rule.”

So today I re-read that section, then went online and found the original article in the Journal of Applied Microbiology and Googled the lead author. Dr. Paul Dawson is a Professor of Food Science at Clemson, got his PhD at North Carolina State University, then did a two-year post-doctoral fellowship. Since joining the Clemson faculty he’s published over 80 research manuscripts.

He was on a CNN TV show in 2010 discussing the 5-second rule, double-dipping (chips into a cheese or salsa dip) and, most recently was working on a project on the bacteriologic safety of blowing out birthday candles (See link below).

I read the online 2006 version of the original article in the Journal of Applied Microbiology, which appeared in paper format in April of 2007. Some of the background data is of interest: over 75,000,000 cases of food-borne illness occur in the United States each year and 5,200 of these result in deaths. Dawson’s experiments were performed using Salmonella bacteria, which is found in a substantial percentage of poultry, roughly 10% in two studies by the USDA.

Every surface is a danger zone

My take on Dawson’s results is 1). bacteria excrete chemicals allowing them to adhere to nearly any kind of surface (e.g., tile, rugs, cutting boards); 2). once they do so they have “biofilms,” microscopic layers that allow them to survive for extended periods of time; 3). they can transfer from those surfaces to a variety of foods (Dawson used bread and bologna) very rapidly; so 4). the five-second rule is invalid and we all need to work on more effectively cleaning “food contact surfaces (counter tops and cutting boards come to mind).

I enjoyed watching the CNN interview with Dr. Dawson and will be intrigued to find out what his birthday candle research will show. In the meantime, I’ll quit picking up food that has fallen on what appear to be clean surfaces; they’re not.

http://newsroom.blogs.cnn.com/2010/08/01/five-second-rule-urban-myth-or-scientific-fact/

 

 

Do I need to eat my words?

Wednesday, October 19th, 2011

Different choices for different ages

An old friend forwarded an article on vitamins yesterday, one that I read with special interest. It came from MedPage Today, an online medical news service for healthcare professionals that partners with the University of Pennsylvania School of Medicine to offer physicians continuing medical education credit (CME) for reading articles and then answering a few questions.

The article was titled “Vitamin Studies Spell Confusion for Patients” and extensively quoted Dr. David Katz fromYale’s prevention research center. He is an adjunct Associate Professor at Yale’s School of Medicine and an internationally renowned authority on nutrition. He comments that, based on the recent study I mentioned several posts ago, many clinicians say they’ve written off supplements for good.

Yet 50% of Americans take supplements; many take more than just a multivitamin.

Then Dr. Katz offers some caveats as I did, stating the Iowa study is “merely observational and can’t prove cause and effect.” He still recommends omega-3 fatty acids (AKA “fish oil”) and vitamin D for most of his patients and adds calcium for women and prenatal vitamins and folic acid for pregnant women. otherwise he only uses vitamins when there are deficiencies.

A recent pole of clinicians found that 70% favor annual screening of specific vitamin levels to treat deficiencies. Which vitamins (and minerals) might be measured as part of an annual focused screening examination and whether medical insurance plans would cover such laboratory tests has not been delineated, as best I can find.

But I’m seventy, and articles from 2005 to 2010 in authoritative sources, talk about seniors needing much more B12, having multiple minor, but significant, vitamin deficiencies, and not eating well-balanced, healthy diets, even here in the United States, much less in other spots around the world. I’m lactase deficient and small-boned; do I need a calcium supplement?

clearly the best way to get your vitamins

I agree with Dr. Katz that eating a balanced diet would be a better answer, at least for those who are younger. The concept of “eating your colors,” i.e., having multiple suit and vegetable dishes over the day which contain different phytochemicals as represented by the color of the food itself, makes great sense.

How many Americans do that at present or are likely to do that even if medical figures recommend such?

I regard this as an ongoing discussion. Dr. Katz is certainly correct in saying that vitamins have been shown to treat disease states, but not to prevent chronic disease. The surmise in the article in MedPage seems sound to me: vitamin isolates are less effective on their own and a full blend of antioxidants and phytochemicals (again, best found in those whole fresh fruits and vegetables, may be the key to obtaining maximum benefits.

This discussion is likely to go on and on, so I’ll supply two URLs that may help you, in consultation with your own physician, make choices that are relevant to your nutritional status, age and degree of health.

http://www.uspharmacist.com/content/d/senior%20care/c/21981/

http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ucm110493.htm

It’s Yo-Yo time again

Wednesday, October 12th, 2011

take pills or eat right, is that the question?

 

 

 

 

A recent edition of The Wall Street Journal had an article titled “Supplements Offer Risks, Little Benefit, Study Says.” It quoted a long-term study of Iowa women, uniform Caucasian and with a mean age of 61.6 in 1986 when the research began. This was not a prospective, randomized controlled trial (RCT), but a cohort study, i.e., a number of people grouped together for a particular reason.

When I Googled the original purpose of the research project I found the following statement:

The Iowa Women’s Health Study (IWHS), started in 1986, is a cohort of 41,836 postmenopausal women aged 55-69 at baseline. The primary aims of the study were to:

1) Determine if the distribution of body fat (waist/hip) predicts incidence of chronic diseases, with the primary endpoints being total mortality, and incident cancers of the breast, endometrium, and ovaries, and

2) Determine to what degree diet and other lifestyle factors influence risk of chronic disease.

So who could resist this incredible pool of data?  I was intrigued to note the authors of this paper were from Finland, Minnesota, South Korea and Norway; three were PhDs and one had a Doctorate in Pharmacy + a Masters degree in Public Health. I somewhat doubt they were the originators of the IWHS.

I found other papers stemming from this study: one concluded that drinking lots of decaf coffee was associated with less type 2 Diabetes, another looked at rheumatoid arthritis, another at colon cancer incidence.

I renewed my long-expired membership in the American Medical Association this morning (it’s very inexpensive for an older retired physician) in order to have access to the full article.These authors looked at vitamin and mineral supplement use in 38,772 of the women. I agree with their take on supplement use in general (it helps in those clearly deficient; the rest of us who take them do so in hope of preventing chronic diseases and lowering our risk of dying prematurely).

The data from numerous studies, in terms of mortality risk, has been inconclusive. There have only been a few RCTs (mostly looking at calcium supplementation and vitamin use) that have said it’s good to take supplements. Others have said not only do they not help, they may harm.

I read the conflicting reports with a jaundiced eye, but this one has a lot of accumulated data and it’s at least worth paying close attention to. The basic conclusions in this particular population set (white women in Iowa) were that calcium supplements are good, iron supplements are bad and the rest don’t help.

There are a few, maybe more than a few caveats. This is an association, not a causation, although the authors tried to eliminate many of the possible differences between those who did and those who did not take supplements. The fact that this wasn’t an RCT meant the two groups differed in a number of fundamental ways. This was not a study originally set up to test if supplements helped or hurt or neither.

Bottom line: the paper is impressive, but won’t change my own use of supplements in any way