Archive for the ‘Life extension’ Category

Will I live a much longer life than I expected?

Friday, May 20th, 2016

In April I became three-quarters of a century old. I am basically healthy and I'm in the gym six days a week although I've got five orthopedic/metabolic issues even after having a right total knee surgery fifteen years ago and three low back operations. The "Curse of the Springbergs'" back continues to plague me; a nerve in the left side of my neck is pinched from time to time; my right shoulder is intermittently painful; I have a trigger finger on my dominant hand and I've had, in the last four months three attacks of gout or perhaps pseudogout, where the crystals deposited aren't uric acid,, but a calcium compound. My recent blood test for my uric acid level was right in the middle of the accepted normal range; that doesn't mean the attacks weren't gout, but deterred my podiatrist from giving my a prescription for allopurinol which could potentially prevent further attacks.

On the other hand, my brain still works pretty well and I'm below my college wrestling weight, so I would potentially be interested in living a long life and treating those nagging, but admittedly minor ailments.

Most members of my family have lived to considerable ages, with only one self-inflicted exception (not suicide, just terrible eating habits resulting in gaining fifty pounds plus really poor adherence to medications prescribed). My mother died at ninety, my father was nearly ninety-five, his sister was ninety and three aunts on my mother's side lived to ninety.

So I was intrigued by an article that appeared in The New York Times recently titled "Chasing Immortality: Dogs Test Drug Aimed at Humans' Biggest Killer: Age. (1)

We typically think of people in developed countries dying, as my wife did in late December at age seventy-five, of a stroke, or as my brother (vide supra) did at fifty-seven, of a heart attack. Cancer, diabetes and Alzheimer's (and other dementias) are also common causes of death in our population, but the article pointed out that "treatment breakthroughs" for these maladies, although crucial for those affected, would likely increase our overall populations life expectancy by just a few years.

I looked at the reference cited in the article. It's a 1990 article in the journal Science and only the abstract is easily available, but its bottom line was even if we found cures for those "major degenerative diseases," it would only result in raising the life expectancy at birth to 85 years, not the Biblical 120, much less even longer life spans.

Now there's a canine trial of rapamycin, a drug first isolated in 1972 from a bacteria found on Easter Island and named after the native designation for that island, Rapa Nui. It was originally developed to fight fungal infections, but later used in preventing organ transplant rejections. It has been shown to increase lifespan in mice. Whether rapamycin slows down aging, however, remains unclear.  The life-extending effect seems to be related to rapamycin's suppression of tumors, which represent the main causes of death in in those animals. (2)

The early results in canines are promising, but the research reported is what's termed by the NIH as a Phase One study, a relatively brief test of a new drug in a small group of subjects to evaluate its safety, determine a safe dosage range, and identify side effects. Bela, the eight-year-old dog featured in the article may have been given rapamycin or may actually be receiving a placebo.

After Phase One we would have considerable time before humans got the drug in a clinical trial, much less having the drug available to your physician or mine for more general use. The dog studies would likely go through Phase Two and Phase Three studies; then there would be considerable discussion before a human Phase One test was started. And there are other phases to accomplish before approval of rapamycin for the purpose of life extension in our species. I copied and pasted definitions of those phases for you and added a few comments.

Phase II studies test the efficacy of a drug or device (Does it work for the particular purpose intended, in this case extending our life span?). This second phase of testing can last from several months to two years, and involves up to several hundred patients. Most phase II studies are randomized trials where one group of patients receives the experimental drug, while a second "control" group receives a standard treatment or placebo. Often these studies are "blinded" which means that neither the patients nor the researchers know who has received the experimental drug. (This is crucial since the hope is to eliminate the "placebo effect...I got the new medicine; I'm feeling better, so it must be from that drug. This is called  the "Post hoc, ergo propter hoc" fallacy. It happened after X, so it must have been caused by X. An extreme and silly example would be the sun came up and shortly thereafter I had a car accident, therefore sunrise causes car crashes.) A Phase Two study allows investigators to provide the pharmaceutical company and the FDA with comparative information about the relative safety and effectiveness of the new drug. About one-third of experimental drugs successfully complete both Phase I and Phase II studies.

Phase III studies involve randomized and blind testing in several hundred to several thousand patients. This large-scale testing, which can last several years, provides the pharmaceutical company and the FDA with a more thorough understanding of the effectiveness of the drug or device, the benefits and the range of possible adverse reactions. 70% to 90% of drugs that enter Phase III studies successfully complete this phase of testing. Once Phase III is complete, a pharmaceutical company can request FDA approval for marketing the drug. (This is the one we should wait for when we read early reports of a new medication that may help a medical issue we are afflicted with).

Fortunately, there is another phase, one that has a number of purposes that drug companies are interested in, but one that can protect our larger population, especially when the new use of an old drug leads to a much larger group of us being exposed to the drug.

Phase IV studies, often called Post Marketing Surveillance Trials, are conducted after a drug or device has been approved for consumer sale. Pharmaceutical companies have several objectives at this stage: (1) to compare a drug with other drugs already in the market; (2) to monitor a drug's long-term effectiveness and impact on a patient's quality of life; and (3) to determine the cost-effectiveness of a drug therapy relative to other traditional and new therapies. Phase IV studies can result in a drug or device being taken off the market or restrictions of use could be placed on the product depending on the findings in the study. (I underlined the last sentence, as this is a further protection for those of us in the general population, assuming we weren't lucky enough to be in a study group. I have a friend who had cancer, with a recurrence after surgery, but got into a Phase Three study and is now cancer-free.)

I found a list of 35 such medications, including Quaalude and Vioxx that have been withdrawn from the market in the last forty or so years. Quaalude is now a Schedule One drug, taking its place alongside heroin. Vioxx was implicated in over 27,000 deaths. (3)

It's a juggling act, to use a phrase that may seem inappropriate. What if rapamycin extended the life span of 98% of those who got it long-term, but severely damaged or even killed 2%. Would you take the drug under those circumstances? Would you want it banned from being prescribed?

What if, in extending human life span, it also allowed time for researchers to come up with treatments or even cures for that list of the major killing diseases?

Mull over those tough questions...we've got a few years before they need to be answered.

Links: (1)                                                                                                               (2)                                                                                                                                         (3)





Surviving, or better still, preventing heart attacks: Part 1: After it happens

Friday, May 18th, 2012

Heart attacks frequently cause sudden cardiac arrest

The April 17, 2012 edition of The Wall Street Journal had an article titled "The Guide to Beating a Heart Attack." It had both good news and bad: since the 1970s the annual number of American deaths from heart attacks (the "med-speak" term is myocardial infarction or MI) has diminished by three fourths; on the other hand nearly a million of us will have an MI this year and many of those will die.The National Vital Statistics Reports estimate for 2010 was 595,000 deaths from heart disease (of all kinds)  and the Seattle-King County 2012 estimate is 480,000 adults dying from an MI or its complications.

A quarter million die from sudden cardiac arrest (SCA) and the majority of those happen in a non-hospital location. Only 7.6% of people who  have an SCA outside a hospital survive to be discharged to home. This figure varies markedly according to where you live. If you happen to reside in Rochester, NY, your odds are much better. Bystander-witnessed cardiac arrest victims there who have the typical heart rhythm disorder that leads to sudden cardiac arrest (it's usually due to a chaotic quivering called ventricular fibrillation{VF}), have a 50% chance of survival to discharge from the hospital.

My mother, as I've mentioned before, was one of the fortunate ones. She didn't live in Rochester or in the Seattle area which also has a superb track record.  But she had a bystander-witnessed event, got prompt CPR and a rapid response from a trained Advanced Cardiac Life Support (ACLS) team, and lived another 16 years.

The Seattle-King County concept is termed "Community Responder CPR-AED." They knew that most people who die from SCA have VF and the only "cure" was to use a defibrillator. Most non-medical people wouldn't be able to operate the complex gadgets used in hospitals. The answer was the AED, an automated external defibrillator developed nearly twenty years ago.

The American Heart Association" Science Advisory commentary on AED use by non-medical people has a four-point program for out-of-hospital SCA: early recognition followed by a 911 call; early bystander-performed CPR; early AED use and then early ACLS.

look for this sign

They included several extra points I hadn't thought about, having always performed CPR-defibrillation & ACLS in hospital settings. Early CPR increase the possibility that defibrillation will stop VF and the heart will then resume its normal rhythm; it does so while providing blood flow to the brain as well as the to heart. And all the AED does is stop the VF abnormal heart rhythm enabling the heart to restart normal beating, but the heart rate may be slow to begin with, so CPR may be necessary for several more minutes.

Early CPR also increases overall survival rates; if it's not being provided, every minute between the patient's collapse and defibrillation lowered that rate by 4-6%.

Given all that, one of the first things the state of Washington did was to pass a law granting immunity from civil liability for any person (or entity) who acquires a defibrillator. Then they started wide-spread CPR and AED training (learning to use an AED is easier than learning CPR) and markedly increased their paramedic numbers.

The life-saving results have been very impressive. My question now is whether to buy an AED for our home.


Adults, obese and otherwise

Sunday, February 12th, 2012

PIck well and cut back your waste/waist

In my last post I explained the concept and the math behind the body mass index (BMI) approach to evaluating if your weight was normal or not (your BMI is very  well in synch with the most scientific methods of determining body fat percentages). Now I want to expand on that a bit  with some recent statistics and some thoughts on how we can lose weight if we need to. Unfortunately, some of us have lots of extra pounds we should shed if we want to have our best shot at leading long, healthy lives.

The Feb 1, 2012 issue of JAMA had a number of interesting articles on obesity. I've previously mentioned several on childhood and adolescent obesity; today I'd like to zero in on two whose focus is American adults.

Four CDC staffers, led by Katherine Flegal, PhD, published the most recent statistics from a recurring national survey with the daunting acronym NHANES. This national health and nutrition survey (the E stands for examination) started in 1971, but from 1999 on has been released results in two-year cycles. The current article from the National Center for Health Statistics, looking at the 2009-2010 NHANES data had a little good news and lots of bad news.

After 1980, until the turn of the 21st century, the prevalence (scientific term for percentage) of obesity in our population kept zooming up. Now it appears to have leveled off. I guess that's something we should be happy about, except now over 35% of adults in this country are obese. Men and women have about equally high rates of obesity and men have caught up to women in this regard over the last twelve years. Some subsets, by sex and racial groups, are even more likely to be obese or very obese.

The worst news from this article was that no group--men, women, non-Hispanic whites, Hispanics or non-Hispanic blacks--had a decrease in the prevalence of obesity in this most recent data set.

So which exercise and diet should we try?

getting enough exercise is difficult when your joints hurt

Many adults report "No Leisure-Time Physical activity." Overall, more of us are exercising, but the data vary from state to state. Those who have arthritis, fifty million in the US, need special attention or are even more likely to get no exercise. The CDC has worked with the Arthritis Foundation to develop ideas for this huge group. Going back to my review of articles on youngsters, I think for the rest of us, we could begin with simple steps, parking at the far end of the parking lot and substituting some walking for part of our screen time as two examples.

Harvard Medical School's free online HEALTHbeat publication had a review of pros and cons of various diets in its Feb 7, 2012 edition. The bottom line still is if you want to lose weight, you must cut down on your calories. The Mediterranean-style emphasis on fruits and vegetables, unrefined carbohydrates, nuts, seeds and fish may be the most effective in reducing cardiovascular and diabetic risks.

My New Year's Resolution is to keep my weight under 150 pounds. I have to work at it as I like to eat, but most of the time I've stayed away from splurges.

How about you?





Eating and drinking in Europe: part two

Wednesday, October 5th, 2011

I may switch to red wine

I've been reflecting about our wine drinking in Europe. Here I normally have one glass of sweet white wine (e.g., Riesling Spatlese) three times a week.  It's very rare that I'll have a second glass and when that occurs it's almost always at home. When we're at an evening event we routinely have a "designated drinker" and a designated driver. That's been our pattern for more than twenty years, ever since I saw an Army senior physician, about to move into a choice command position, make the irrevocable error of over-consumption of liquor at a party.

I've noticed a few months ago that other countries have considerably lower blood alcohol limits for drivers than ours in the United States: that altered my own behavior. Rarely in the past, if we were going to spend three or four hours at a party, I might have one drink at the start of the festivities and drive home some hours later. That no longer makes sense.

However, in Portugal, we almost always walked to restaurants and we almost always drank red wine: vino verde (I discovered this meant "young wine", not "green wine), Port or regional products. We were sitting next to a German couple at one delightful meal and started talking about our imbibing habits. They had a white wine bottle on their table while we were trying a local red . They said at home they usually have wine with dinner and drink a bottle every three days. On vacation, they were drinking a bottle a night.

We brought a half bottle back to the hotel and finished it the following evening sitting on the third-story terrace.

Normally, if I do have a second glass of wine I feel a slight buzz. That wasn't happening on this trip. When I thought about it I realized we weren't drinking standing up at a reception, but sitting down at a prolonged meal. Our typical dinner in the States lasts an hour; here we averaged two and a half hours. So both the length of time and our food intake played a part in moderating the effect of the alcohol we were consuming.

We're home now and back to our normal pattern. We ate at our favorite local restaurant yesterday and I had a Thai Ice tea and no wine.

I'm not suggesting any of you should start drinking wine if you don't now, and for those of you who do drink wine now I'm certainly not pushing for increased amounts (having seen far too many cases of cirrhosis). The medical data for a favorable effect of moderate red wine consumption is suggestive, but not definitive as I mentioned in my comments extracted from a Mayo Clinic website. At age seventy, with no history of overconsumption in my family, I'm choosing to err on the side of  the vino. I may even switch from white to red wine.

Eating and drinking European style

Friday, September 30th, 2011

Living and eating at a vineyard

We're just back from 3+ weeks in Europe, almost all of that in Portugal. We had keys to an apartment situated in a village west of Lisbon and owned by old friends. Downstairs was a superb Brazilian restaurant and 100 feet from our buildings door was another, more casual eatery in a glass-sided tent-like structure. We dined at those two places a lot, but also rented a car, drove north, and stayed in walled cities, a university town and a farm in the Douro Valley raising grapes for Port wine, olives and some fruit.

We discovered a new style of eating and drinking, far different from American fast food restaurants or home meals eaten on a couch in front of a television set or hurriedly at a table. Many of our dinners lasted well over two hours and almost all were accompanied by red wine.

We had already, over the past few years, changed our style of eating, at least for our evening meal. We move from the kitchen area to the dining room, serve one course at a time, portion out our meat, salad, and vegetables in the kitchen so we don't have platters of food before us as a temptation to refill our plates. We slow down, talk and reflect on our day or on issues of substance. Perhaps three times a week we have a glass of wine, almost always a sweet white varietal. Our dinners often stretch out to an hour in length, sometimes longer.

I've read about the supposed health benefits of red wine (the Mayo Clinic website has an excellent short review on the subject) and, in recent years, realized there are some reds I can drink without having the kind of reaction (mostly nasal stuffiness) I got from Cabernet sauvignon in the early 1970s. I went back to a March 2011 update from Mayo's which, with appropriate cautions, discusses an antioxidant named resveratrol, which comes from grape skins. Because red wine is fermented with grape skins longer than is red wine, it contains more of this polyphenol chemical.

I knew I wanted to try and likely buy some Port. That was easily done during our four-day farm-stay. But elsewhere in Portugal there were various other local red wines. So we walked from our hotel to a restaurant (I don't drink and drive), ordered some red wine and markedly changed our eating style.

Take a bite, put down the utensil, savor, swallow and then talk for a while. Our meals stretched out to two hours and often beyond. In one restaurant we were next to a French couple and beyond them was a Canadian couple. We entered the place before either and left last.

We usually ate bread (freshly made) and ate desserts. I knew I would gain a few pounds, but I also knew I could lose it quickly when we returned home. The food, on average, was wonderful. We ate lots of fresh fish, lots of vegetables and the occasional mousse de chocolata. We hope to carry over some of those habits now that we're home.



Can there be long Life without Life?

Tuesday, August 30th, 2011

A "fountain with Youth" that's real

I was reading two articles, in our local paper last weekend when I realized I was channeling Yogi Berra and his famous quote, "It's déjà vu all over again. What's happened is a return to Herodotes, the Greek historian (5th century BCE) who told of a fountain in Ethiopia responsible for extraordinary lifespan and to Ponce de Leon, the Spanish explorer who traveled on Columbus' second voyage (1493) and described the Fountain of Youth, supposedly found in Florida.

Now we have a huge contingent of baby boomers (estimates in the 70 million range) who are about to reach 65 and don't want to grow or look older. The market for anti-aging remedies is currently about $80 billion a year and is expected to top $110 billion in the next four or five years. We live in a society that worships youth and many of our compatriots are being sold magic potions that some claim will prevent aging or at least most of its signs.

One of the articles had an amazing photo of Dr. Jeffrey S.Life, age 72, a body builder and author of a book titled The Life Plan: How Any Man Can Achieve Lasting Health, Great Sex and a Stronger, Leaner Body. You can buy this $26 book for $14.94 on Amazon, but I think I'll skip it.

Dr. Life's program includes diet, exercise and a healthy lifestyle; it also features, for at least some of his patients, injections of human growth hormone (at roughly $15,000 a year) plus testosterone.

The data on these hormone replacement regimens is, to say the least, not as rock solid as Dr. Life's toned torso. The NIH has a division called the National Institute On Aging (see link below), and the Geriatrician who heads this organization is solidly against widespread use of hormone replacement therapies.

What makes sense to me is exercising regularly, staying lean (or getting there) and stopping smoking. I noted that Dr Life's mentor died at age 69, a long ways short of my physician Dad's 94-year lifespan. Dad ran most days until his late 70s, stayed trim and quit smoking as a young doc when he realized he had three cigarettes going in three ashtrays in his three-room office.

lots of these out there

I think many baby boomers and others would like to find a magic bullet, a tonic or elixer that would allow them to eat what they want, do what they want and live to 100.

Until you show me a long-term, controlled study that points that way, I think we're as shy of the Fountain of Youth as we were in the days of Ponce de Leon or Herodotes.

Eat less and spend your money on a health club membership or a pair of running shoes instead.

Post-exercise protein choices, part 1

Friday, June 17th, 2011

Maybe a few more pounds than this

I received a comment recently on one of my April 2011 posts asking if I still had the April edition of the Nutrition Action Health Letter (NAHL) published by the Center for Science in the Public Interest. My reader had lost her copy and wanted to know what protein supplement CSPI thought was reasonable. I found the info (it was creatine monohydrate with background research done by an associate professor at the University of Regina in Saskatchewan), emailed it to her and decided to review the whole topic in more depth.

I'm in the gym six or seven days a week for ~two hours or a tad more. I'm not trying to bulk up and never attempt the weights I see some of the really husky guys lifting.

As I walk in, I pass a lineup off supplements and see men especially, mixing up powders from large containers. I've never even considered the idea. I told my reader that the professor's credentials seemed reasonable, but she should ask her own physician before starting any supplements from a bottle. I also mentioned that I hard boil eggs, compost the yolks and eat the whites at meals that are otherwise low in protein.

But I reread the article in the April NAHL "Staying Strong: How exercise & diet can help preserve your muscles." The opening quote caught my eye. Miriam Nelson, the director of Tuft's Center on Physical Activity, Nutrition and Obesity Prevention said, "Muscle is the absolute centerpiece for being healthy, vital and independent as we grow older."

I turned seventy in April, so it made sense to pay attention to her. I'm already active and doing some "resistance training" as was recommended later in the article. I saw also quotes from Ben Hurley, a professor of kinesiology at the University of Maryland (and husband to Jane Hurley, an RD on the NAHL staff).

Hurley has been a longtime student of strength training AKA resitance or weight training and feels it is the mode of choice for preventing muscle loss.

Notice I said preventing loss of muscles, not muscle building. I see men in our gym who are only a few years younger than me and are still bulking up deliberately. The sixteen to twenty-year-old youngsters are presumably doing so to impress the young women or because their friends do so, but why do that at age sixty plus?

I actually bought Stonyfield Organic Oikos yogurt

But back to protein intake; experts like the woman who holds the Distinguished Chair in Geriatric Medicine at the University of Texas Medical Branch, Galveston, say we should consume 30 grams of protein soon after exercising and that smaller amounts won't work in older adults.

So that's four ounces of skinned chicken breast (170 calories) or my egg white plus some Greek yogurt (with twice the protein of regular yogurt). I'll try that a while and then comment on the idea.

Hypertension: some good news

Tuesday, May 31st, 2011

Let's check your BP

I was reading a blog post from May 2010 written by an unidentified cardiologist. Some of the underlying issues were worth following to better sources. The blog stated that high blood pressure is our most common chronic disease. It went on to mention the connection between BP and weight, saying, as a nation, America is one million tons overweight. It claimed that ten pounds of weight loss could normalize the BP of many Americans.

I initially got into today's data search because of a Wall Street Journal article (Personal Journal; May 31, 2010; pp.D1-2) titled "A Long-Awaited Advance in the War on Blood Pressure." I Googled the author, Ron Winslow and he is the deputy editor for health and science and a senior medical and health care writer for WSJ with over a thousand articles written.

He reported that the American Society for Hypertension (ASH) met in New York last week (May 21-24,2011) and Dr. Brent Eagan, the vice president of ASH, and Professor of Medicine at the University of South Carolina reported some real progress on the multi-state Hypertension Initiative he heads. It's working with ~500 primary care practitioners and over 110,000 hypertensive patients in the Southeast. Nearly 70% of their patient have controlled BPs now (vs. 40% a decade ago).

About as far away as you can get in the U.S., Kaiser Permanente's northern California branch follows >600,000 patients with hypertension and reported at the same ASH meeting that 80% of that group have controlled BP readings compared to 44% ten years back.

One of the Kaiser patients had a regular checkup in 2007 and had mildly elevated BPs then (145/74). Her own comment was, "Here in northern California, we believe in exercise and good nutrition and we're not into pills."

Yet her doctors started her on two medications for hypertension and early this year her BP was 117/74. She's walking three miles three times a week, eating fruits and vegetables and going to a strength-training class at a gym. I don't know if she lost weight also, but I wouldn't be surprised. I mentioned in an earlier post, that my own BP fell markedly after I lost ~25 pounds, and the dosage of the anti-hypertensive drug I've been on for years had to be cut in half.

Guess who's at higher risk for CV disease

So why am I writing about this in a blog devoted mostly to weight/diet/exercise?  First, there's an increased awareness of the association between excess weight, high BP and cardiovascular risk at all ages. An article in the Feb 3, 2009 edition of Circulation looked at the issue in children and adolescents. Concentrating on the Metabolic Syndrome (obesity, diabetes, hypertension, abnormal blood lipids), there was, even in these young people, a definite correlation between the degree of obesity and cardiovascular risk. They stated that strong evidence places obesity as the most significant risk factor

Can I tie all this together? Well I'd say bluntly that obesity is our major enemy, it's a major causal factor in hypertension which is being treated pharmacologically at earlier stages and that diet and exercise are extremely useful ways to combat both entities.

Saving $1T by losing pounds

Saturday, April 16th, 2011

whole-grain cereal and a banana

Mark Bittman's "Opinionator" column in the New York TImes April 12, 2011, was right on. He called the $36B that Congress has been haggling over (like two small boys) small potatoes compared to what could be saved if we ate less overall and ate more of the right things. He quoted a number of medical resources, so I went back to look at the originals.

In the January 24, 2011 online edition of the American Heart Association's journal Circulation, a panel headed by a Stanford Associate Professor, Paul Heidenreich, stated that cardiovascular disease (CVD) currently accounts for more than one sixth of all US health dollars spent. They went on to predict that by 2030 the direct costs of care for all forms of CVD would triple from a 2010 estimate of $273B to $818B .

CVD includes stroke, heart attacks, congestive heart failure and hypertension among other entities and they are often highly correlated. In fact the INTERHEART study which Bittman quotes (and I found in a seven-year-old copy of the journal Lancet), says lifestyle-related risk factors such as obesity, smoking and hypertension account for roughly 90+% of heart disease.

We haven't even started on Type 2 diabetes (DM) yet and Bittman noted that problem will cost roughly $500B per year  by 2020. And almost all of the cases of Type 2 DM are preventable.

If we want to reduce the deficit, one way would be to reduce our weights and trim our waistlines. Sure, we wouldn't get rid of all CVD and Type 2 DM, but a large share of the $1.3T per year we will be spending on them by 2020-2030 could be avoided.

We're spending over $2T a year now on healthcare and those costs are going up and up.

So how can we save a major chunk of that huge sum? How about Dr. David Ludwig's ideas? He's a Harvard doc who has worked with Marion Nestle, the PhD dietitian I've mentioned before. He published a very recent article in JAMA (the Journal of the American Medical Association) with both straightforward and complex/innovate modalities to improve our American diet.

I read something about Dr. Ludwig and his earlier concepts in his Harvard bio and a WebMD interview. He's a pediatric endocrinologist working at Children's Hospital in Boston, founding director of its Optimal Weight for Life (OWL) program and author of Ending the Food Fight:Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World.

In the JAMA article he talks about better funding for school lunch programs, making breads with whole grains (non-refined) and research needed to improve food preservatives that are healthier than the current ones. His own studies appear to show a correlation between lower calorie intake and eating whole grain products.

I see two difficult issues: getting people to make healthy foods choices and avoiding bureaucratic costs as the British experienced from their NHS shift toward paying physicians for preventive measures (NB. WSJ article from 4-16-2011 p. C3).

But what a great way to save us money that Congress might even agree on.





The "tippling" point

Tuesday, February 8th, 2011

one too many

My wife clipped an article from The Wall Street Journal last week and stuck in my "read this, Peter" stack she keeps. I got around to it yesterday and was impressed enough to do the background research. The writer had looked at the 2010 Dietary Guidelines for Americans and focused on the beneficial effects of moderate alcohol consumption.

Well that caught my attention; I drink a glass of wine two or three nights a week, rarely drink two and never more than that

The author of the short article, Stanton Peele, is a psychologist, attorney and writer on addiction recovery. He is a PhD, JD who has written nine books on addiction and has a different view than the "Disease Model" that many of us were taught in our medical training. His take is  the "Life Process Model"in which addicts use their drug of choice to cope wih life. I did note that eleven years back some of his research was sponsored by the Distilled Spirits Council and the Wine Institute  (their support of his work ended in 2000).

Okay that made me a sceptic, but I decided to read the section on alcohol in the recently released 2010 DGAC. It begins by emphasizing the hazards of heavy EtOH intake, quoting a 2009 study attributing 90,000 deaths a years to alcohol "misuse" in the United States. It also estimates that 26,000 deaths were averted (I like that term better than prevented since eventually we all die) by moderate EtOH consumption.

The traditional definition of moderate is one or two drinks per day for males and one per day for females. A lot of people exceed those levels with 2009 and 2010 studies showing estimates of 9% of men and 4% of women drinking heavily.

So what's the good stuff assuming you're an adult, not pregnant, don't have a drinking problem and don't have disease that are exacerbated by alcohol? it appears from extensive reviews of the medical literature that moderate drinking isn't associated with weight gain (remembering that EtOH is "empty calories and you still have to eat a balanced diet). Also moderate evidence supports less cognitive decline with age in moderate drinkers and strong evidence "consistently demonstrates" a lower risk of coronary heart disease in moderate drinkers. Bone health as shown by the incidence of hip fractures appears to be improved by moderate drinking.

MVAs and drowning as well as falls are more likley with heavy drinking, but the risk for these is less well estbalished with moderate drinking.

There's even a section on lactation and breastfeeding; Alcohol reduces milk production and decreases infant milk consumption for three to four hours after alcohol is consumed, but the DGAC concluded that after age two to three months, an infant's exposure would be negligable if the mother waited three to hour hours after consuming a single drink before breastfeeding.

And of course nobody is urging you to start drinking if you don't already.

So I'm going out to dinner with my wife and a friend tonight and will order a glass of wine.

But she's going to drive home.