Archive for the ‘scientific controversies’ Category

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

 

 

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.

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.

http://www.nia.nih.gov/

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.

Beating the Heat

Friday, August 12th, 2011

Cooling down

We've been away for a short vacation with our eleven-year-old grandson at Harry Potter Wizarding World in Orlando. It was hot and humid much of the time, although the frequent rain storms helped cool things off.  One of the reasons we moved from the San Antonio area to Colorado after retiring from the Air Force was the heat. My comment in the late 1990s was, "Texas has Summer and the other three days."

I grew up in Wisconsin, my wife in Montana, and although we lived in a number of locales during each of our 20+ years as USAF officers, most of them were in warmer climates. We wanted four seasons in our retirement location and we certainly have them now.

Florida brought back memories of my years in Texas; sixteen of my twenty-three active duty years were spent there. So the article in the August 2, 2011 edition of The Wall Street Journal titled "Spotting and Taming Signs of Heatstroke" caught my attention.

I've had very little experience with heatstroke, but considerable dealings with heat exhaustion, a milder manifestation of heat-related illness. A lot of that was with basic military recruits, many of whom moved to their initial Air Force training from cooler places. Most of my own exercise these days during the summer months is in an indoor setting, so I'm at somewhat lesser risk in spite of being seventy.

Heatstroke killed over 3,000 Americans from 1997 to 2007 and the National Weather Service statistics said 138 in 2010 and at least 64 in thus far in 2011 died from heat-related illnesses. In some years heat causes more deaths than hurricanes or floods, the other major weather-linked agents of fatalities.

Games offer less risk than practice

Hydration, hydration, hydration is a major, but not infallible preventive step with water being ranked as good as sports drinks according to a co-author of the American College of Sports Medicine' guidelines. High-school and college football players, who suffer the majority of heat-related sports deaths, need rest breaks, shade, and water, especially during practice, according to that expert who had his own brush with heatstroke in 1985 during a 10K race. During the games themselves, he says, rest breaks are built in.

Along with athletes (and infants left in a hot car), older adults are at high risk, especially those with underlying diseases treated with medications that can worsen the severity of the reaction to heat.

Treatment of heatstroke is a medical emergency, so early diagnosis is critical. Look for confusion, irrational speech, skin that is red, hot and dry, rapid pulse, throbbing headache, dizziness  and nausea; some of those casualties become unconscious. Call 911 and get the victim into the shade.

Beyond that lies controversy with some professional groups recommending cooling the afflicted person as rapidly as possible in a cold or ice-water bath, others such as the American Heart Association suggesting fanning and sponge-bathing the person or misting them with cool water, rather than ice water.

Looking at online news articles, I think we may break records this year for heat-associated illness and deaths.

 

Should you take multivitamins?

Friday, July 29th, 2011

The best choice is on the right

Eight days ago The Wall Street Journal had an article with an intriguing title, "Multivitamins: Lots of Types, Lots of Label Confusion. The question was "do you really need a multivitamin?" and the answer was, "probably not, although much depends on your age, gender, diet and health.

I take a senior vitamin (I'm 70), 5,000 IU of vitamin D every other day, 500 milligrams of vitamin C and 2,500 micrograms of B12 a day. I also take another vitamin-containing capsule suggested by an ophthalmologist (as my Dad had macular degeneration and there's some data suggesting taking these vitamins plus zinc, selenium, copper, lutein and zeaxanthin can help prevent this disease).

The last two chemicals I mentioned are probably unfamiliar to most of you; but they're found naturally in your eyes, especially in the retina/macula. Zeaxanthin is the pigment that gives paprika  (made from bell peppers), corn, saffron, and many other plants their characteristic color.

The questions I asked myself for these vitamins today were firstly: what are the recommended daily allowances RDAs), the amount from food (and maybe added pills) that are sufficient to meet the nutrient requirements of nearly all (97-98%) healthy individuals in a group. And secondly: what are the tolerable upper intake (TUL) levels for these same vitamins.

Both these querys can be answered by looking at tables supplied by the Institute of Medicine (look at www.iom.edu). The IOM is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. It's been the health arm since 1970 of the National Academy of Science which itself was established by President Lincoln in 1863.

I'll just mention a few of the RDAs and TULs and stick to my age and gender. Remember B vitamins are water soluble, so for most of these there is no upper determined limit. Excess amounts should be excreted in the urine. That doesn't mean you can or should gulp an endless amount of these; to me it just means there is no data on adverse effects.

Vitamins that are fat soluble (A, D, E, and K for most of of us, CoQ10 for those who take this supplement {disclaimer: I know little about CoQ10 and have never taken it myself}), are different. Excess amounts may remain in the body and cause toxicity.

Vitmain C megadoses were advocated years ago by Linus Pauling (who won two Nobel prizes), but large, randomized clinical trials on the effects of high doses on the general population have never taken place and toxicity in some individuals taking high doses has been shown. The RDA for me is 75 mg/d and the TUL is 2,000.

I wondered if I were possibly pushing the upper limits of vitamin A intake, with 2,500 IU (international units) in my senior vitamin and 2,500 IU in the other multi I take, so I looked for the TUL and found it in IU format in the NIH's MedlinePlus website as 25,000 IUs.

Multivitamins are a $4.9 biilion/year industry, so I'd consult your own physician if you want to take them or any supplements.

 

Will this work and is it safe?

Tuesday, July 5th, 2011

The ultrasound said 9 pounds

I'm still digesting Taubes's work with mixed feelings, but his concept that insulin is central in the obesity epidemic took on a new meaning today. I was reading the "Health & Wellness" section of The Wall Street Journal and came across an article titled "Programming a Fetus for a Healthier Life." I was intrigued and read further, finding the U.K. government is backing a research effort in the realm of "fetal programming," changing the uterine environment during pregnancy in an attempt to better a child's health for the better in later years.

This is new turf for me and normally not an area I would have written about; in this case, however, the experiment, thus far only in its early stages, hopes to prevent obesity.

The underlying concept is the work of Dr. David J. P. Barker, who published a theory in 1997 termed the "thrifty phenotype," saying that in poor nutritional conditions, a pregnant woman can modify the development of her unborn child such that it will be prepared to survive in a resource-limited environment. The extension of this says reduced fetal growth is associated with a number of later-life chronic conditions.

Barker is now both Professor of Epidemiology at an English university and Professor in the Department of Cardiovascular Medicine at the Oregon Health and Science University. In 1995 his theory was renamed as the Barker hypothesis by the British Medical Journal. Now it's being applied in a very different setting.

a model of human insulin

The study is attempting to enroll obese pregnant women, 400 of them, in a trial of an oral agent called Metformin, normally utilized to treat type-2 diabetes, to lower their blood sugars, which tend to run higher than normal. The thought is that glucose is passed on to babies in utero and they then end up larger than normal birth weights and elevated insulin levels, setting the stage for lifelong obesity.

Dr. Jane Norman, a maternal-fetal health specialist at the University of Edinburgh is a lead investigator. A prominent US specialist, on the board of the 2,000-member Maternal-Fetal Medicine Society and not involved in the study, says he'd have no qualms about his patients joining the Metformin-taking moms-to-be.

I searched the literature and found the following

"Does metformin cause birth defects? Is it safe to take it during the first trimester?

Most studies suggest that metformin is not associated with an increased risk of birth defects. Some early trials suggested that the use of metformin during the first trimester was associated with an increased risk of birth defects. However, it is not clear whether these were caused by metformin or poor control of the mothers’ diabetes. More recent trials studying the safety of metformin during pregnancy, mostly when used to treat insulin resistance in women with PCOS (polycystic ovary syndrome), did not show an increased rate of birth defects or complications at birth."

So the concept appears to be a reasonable test of whether the uterine environment can be safely altered with a drug to prevent obesity.

Wow!

Reading Taubes: part one

Saturday, July 2nd, 2011

Avoid white bread

A while back one of my blog readers asked if I had ever read Taubes. I wasn't sure if that was a book title, a diet plan or an author, so I Googled the word and eventually purchased two books written by a veteran science writer, Gary Taubes.

Taubes studied applied physics at Harvard and areospace engineering at Stanford, then wrote articles for Discover and Science plus four books. He looks for scientific controversises and wades into them. In July 2002 he published an article in the New York Times Magazine titled "What if it's All Been a Big Fat Lie,"

The article takes us back to the Adkins diet craze. Dr. Atkins, trained in cardiology, was significantly overweight and used a JAMA study as a basis for his own personal diet plan. He then published two books urging dieters to severely limit carbohydrate consumption. At one point it was estimated that one out of eleven North American adults were on his diet. His company made over $100 million, but filed for Chapter 11 bankruptcy in 2005, two years after he died.

Taubes explores some of the same turf, saying it's refined carbohydrates that make us fat. His initial plunge into the field was the NYT piece, followed by a 2007 book, Good Calories, Bad Calories and now a 2011 book, Why We get Fat: and What to do About It.

Taubes has hefty credentials as a science writer; he is the only print journalist to have received the Science in Society Journalism Award three times. Currently he's a Robert Woods Johnson Foundation investigator in Health Policy Research at UC Berkeley's School of Public Health. But his initial article ignited a firestorm. In the piece Taubes mentions that the common veiwpoint links the kickoff of the obesity epidemic  (in the early 1980s), to cheap fatty foods, large portion servings (at commercial establishments presumably), an increase in food advertisements and a sedentary lifestyle.

He would beg to differ, invoking what he terms "Endocrinology 101," an explanation that says human evolution was not designed for a high-sugar, high-starch diet. Until a comparatively recent era (roughly 10,000 years ago) we were not agriculturists, but hunter-gatherers. So Taubes thinks the problem is our increased consumption of sugar, high fructose corn syrup, white bread, pasta &  white rice.

Others think he picks and chooses his facts. I don't think he's wrong in his basic premise, but he also disagrees with the ideas of "calories in; calories out," avoiding saturated fats and exercising being important in weight control (He seems to think people who exercise then hurry off to eat more).

more than one way to "thin a cat"

I'm down thirty pounds since early in 2009, have easily kept the weight off by exercising six days a week, avoiding sugar & HFCS foods and eating lots  more veggies and fruits while cutting back on portion size of meat dishes.

I'll read more on Taubes and his detractors and let you know what I agree with and what I don't.