Medical Wisdom

Paying a Price for Loving Red Meat

icedragon — Sat, 23 May 2009 06:15:19 +0000

April 28, 2009

Personal Health

There was a time when red meat was a luxury for ordinary Americans, or was at least something special: cooking a roast for Sunday dinner, ordering a steak at a restaurant. Not anymore. Meat consumption has more than doubled in the United States in the last 50 years.

Now a new study of more than 500,000 Americans has provided the best evidence yet that our affinity for red meat has exacted a hefty price on our health and limited our longevity.

The study found that, other things being equal, the men and women who consumed the most red and processed meat were likely to die sooner, especially from one of our two leading killers, heart disease and cancer, than people who consumed much smaller amounts of these foods.

Results of the decade-long study were published in the March 23 issue of The Archives of Internal Medicine. The study, directed by Rashmi Sinha, a nutritional epidemiologist at the National Cancer Institute, involved 322,263 men and 223,390 women ages 50 to 71 who participated in the National Institutes of Health-AARP Diet and Health Study. Each participant completed detailed questionnaires about diet and other habits and characteristics, including smoking, exercise, alcohol consumption, education, use of supplements, weight and family history of cancer.

Determining Risk

During the decade, 47,976 men and 23,276 women died, and the researchers kept track of the timing and reasons for each death. Red meat consumption ranged from a low of less than an ounce a day, on average, to a high of four ounces a day, and processed meat consumption ranged from at most once a week to an average of one and a half ounces a day.

The increase in mortality risk tied to the higher levels of meat consumption was described as “modest,” ranging from about 20 percent to nearly 40 percent. But the number of excess deaths that could be attributed to high meat consumption is quite large given the size of the American population.

Extrapolated to all Americans in the age group studied, the new findings suggest that over the course of a decade, the deaths of one million men and perhaps half a million women could be prevented just by eating less red and processed meats, according to estimates prepared by Dr. Barry Popkin, who wrote an editorial accompanying the report.

To prevent premature deaths related to red and processed meats, Dr. Popkin suggested in an interview that people should eat a hamburger only once or twice a week instead of every day, a small steak once a week instead of every other day, and a hot dog every month and a half instead of once a week.

In place of red meat, nonvegetarians might consider poultry and fish. In the study, the largest consumers of “white” meat from poultry and fish had a slight survival advantage. Likewise, those who ate the most fruits and vegetables also tended to live longer.

Anyone who worries about global well-being has yet another reason to consume less red meat. Dr. Popkin, an epidemiologist at the University of North Carolina, said that a reduced dependence on livestock for food could help to save the planet from the ravaging effects of environmental pollution, global warming and the depletion of potable water.

“In the United States,” Dr. Popkin wrote, “livestock production accounts for 55 percent of the erosion process, 37 percent of pesticides applied, 50 percent of antibiotics consumed, and a third of total discharge of nitrogen and phosphorus to surface water.”

Finding a Culprit

A question that arises from observational studies like this one is whether meat is in fact a hazard or whether other factors associated with meat-eating are the real culprits in raising death rates. The subjects in the study who ate the most red meat had other less-than-healthful habits. They were more likely to smoke, weigh more for their height, and consume more calories and more total fat and saturated fat. They also ate less fruits, vegetables and fiber; took fewer vitamin supplements; and were less physically active.

But in analyzing mortality data in relation to meat consumption, the cancer institute researchers carefully controlled for all these and many other factors that could influence death rates. The study data have not yet been analyzed to determine what, if any, life-saving benefits might come from eating more protein from vegetable sources like beans or a completely vegetarian diet.

The results mirror those of several other studies in recent years that have linked a high-meat diet to life-threatening health problems. The earliest studies highlighted the connection between the saturated fats in red meats to higher blood levels of artery-damaging cholesterol and subsequent heart disease, which prompted many people to eat leaner meats and more skinless poultry and fish. Along with other dietary changes, like consuming less dairy fat, this resulted in a nationwide drop in average serum cholesterol levels and contributed to a reduction in coronary death rates.

Elevated blood pressure, another coronary risk factor, has also been shown to be associated with eating more red and processed meat, Dr. Sinha and colleagues reported.

Poultry and fish contain less saturated fat than red meat, and fish contains omega-3 fatty acids that have been linked in several large studies to heart benefits. For example, men who consume two servings of fatty fish a week were found to have a 50 percent lower risk of cardiac deaths, and in the Nurses’ Health Study of 84,688 women, those who ate fish and foods rich in omega-3 fatty acids at least once a week cut their coronary risk by more than 20 percent.

Ties to Cancer

Choosing protein from sources other than meat has also been linked to lower rates of cancer. When meat is cooked, especially grilled or broiled at high temperatures, carcinogens can form on the surface of the meat. And processed meats like sausages, salami and bologna usually contain nitrosamines, although there are products now available that are free of these carcinogens.

Data from one million participants in the European Prospective Investigation Into Cancer and Nutrition trial found that those who ate the least fish had a 40 percent greater risk of developing colon cancer than those who ate more than 1.75 ounces of fish a day. Likewise, while a diet high in red meat was linked to an increased risk of prostate cancer in the large Selenium and Vitamin E Cancer Prevention Trial, among the 35,534 men in the study, those who consumed at least three servings of fish a week had half the risk of advanced prostate cancer compared with men who rarely ate fish.

Another study, which randomly assigned more than 19,500 women to a low-fat diet, found after eight years a 40 percent reduced risk of ovarian cancer among them, when compared with 29,000 women who ate their regular diets.

7 Health Myths

icedragon — Thu, 07 May 2009 00:17:37 +0000

drawSponsorPromo();
// –>

Feed a Cold, Starve a Fever

It’s a good idea to feed a cold but a bad idea to starve a fever, since your body needs nutrition at all times for healing. When your temperature goes up, so does your metabolism—which means your body requires calories more than ever to carry out basic functions like breathing and pumping blood. Not eating will only make it harder for your body to fight off the illness.

drawSponsorPromo();
// –>

If I’m Not Overweight, I’m Not at Risk of a Heart Attack

Just because your weight is normal doesn’t mean you are out of the woods when it comes to heart disease. Some people are born with a genetic predisposition to high cholesterol. They may look like the picture of health from the outside, but inside they can have dangerous plaque blocking their coronary arteries, the arteries that surround the heart. Know your total cholesterol, the breakdown of the “good “ and “bad” components of cholesterol, and your triglycerides. And don’t smoke. Smoking is the fastest way to a heart attack.

drawSponsorPromo();
// –>

The Biggest Breeding Ground for Germs in Your Bathroom Is Your Hairbrush

Actually, it’s your toothbrush. We know from research that used toothbrushes are contaminated with millions of germs from our mouths, from the bathroom, and from neighboring toothbrushes. To keep germs from spreading, don’t share toothbrushes or let your toothbrush make contact with any other toothbrushes stored in the same holder. A good rule of thumb is to keep them at least an inch apart. Also, get a new toothbrush after you’ve had any illness such as a cold or flu because germs can remain even after you’ve recovered.

drawSponsorPromo();
// –>

Donating Blood Only Helps Others

The life you save may be your own. Preliminary studies suggest you can lower your risk of heart disease by regularly giving blood. This helps mitigate the amount of iron in your body. Many researchers think that we take in too much iron, mostly from eating red meat. Excess iron is thought to aid in the creation of free radicals in the body, speeding the aging process and raising the risk of heart disease, cancer and Alzheimer’s disease. Until menopause, women are naturally protected from iron overload, but after that the danger of overdose climbs. But don’t rely on donating blood alone. Go easy on the red meat: no more than a few servings a week and keep each to the size of a deck of cards.

drawSponsorPromo();
// –>

Reading in Dim Light Will Ruin Your Eyesight

While you were growing up, your mother probably told you, “Don’t read in the dark or you’ll go blind!” Not true. You won’t damage your eyes by using them. Reading in low light will not change the health or function of your eyes. You’ll see better if the lighting is optimal, but dim light has no permanent effect on the structure of your eyes. Even so, reading in dim light can lead to temporary eyestrain. So find a good lamp, and keep your reading material at least twelve inches away from your eyes. Then take a break from reading every twenty minutes or so to give your eyes a rest.

drawSponsorPromo();
// –>

Coffee Has No Effect on Cholesterol

Filtering coffee with paper filters removes a natural compound called cafestol that can increase levels of artery-clogging LDL cholesterol in your blood…Save the strong unfiltered coffee like espresso, cappuccino, Turkish coffee, and coffee brewed from French press coffeemakers for an occasional treat.

drawSponsorPromo();
// –>

Happiness Is Just a State of Mind

A growing body of research says happiness is not only a state of mind, it’s a state of health. In one study at Carnegie Mellon University, researchers found that “happy” subjects exposed to cold and flu viruses were less susceptible to illness than their more negative counterparts. The other study was done in a most unusual place—at Villa Assumpta in Baltimore and at six other convents around the United States. Researchers looked at short autobiographies of 678 nuns. They found that those who used the most “positive” words lived, on average, ten years longer than nuns expressing more negative emotions.

10 Ways To Keep Your Brain Sharp

icedragon — Tue, 05 May 2009 00:06:04 +0000

Tease your brain

Whether crossword puzzles, sudokus and other brain teasers actually keep your brain in shape, has not been well-established. However, lack of education is a strong predictor of cognitive decline. The more you’ve tried to learn, the better you’ll be at mental sit-ups in old age. The key may be tackling something new; the challenge of the unknown is likely more beneficial than putting together the same jigsaw puzzle over and over again.Supplements have been getting a bad rap recently, with even the familiar multivitamin now looking like a waste of money — or worse. Brain pills, such as ginkgo and melatonin, likely belong in the trash as well. Despite their “natural” origins, they are not free of potential side effects, such as high blood pressure, digestion trouble, fertility problems and depression. And among healthy individuals, ginkgo offers no brain benefits beyond that of a placebo. (In some cases, the placebo worked better.)Stress takes a toll on the brain by washing harmful chemicals over the hippocampus and other brain areas involved in memory. Some scientists suspect that living a balanced lifestyle and pursuing relaxing activities such as yoga, socializing and crafting may delay memory impairment by reducing stress.Some theories credit the introduction of fish into the human diet with the evolution of our tremendous cognitive prowess. Essential fatty acids, such as Omega 3s, are critical to brain function and are proving beneficial for treating such brain-sapping ailments as depression. Studies on the efficacy of Omega 3 supplements, however, have had mixed results, so get doses from food sources, such as flax seeds, fatty fish and grass-fed animals.Growing evidence suggests a caffeine habit may protect the brain. According to large longitudinal studies, two to four perk-me-ups a day may stave off normal cognitive decline and decrease the incidence of Alzheimer’s by 30 to 60 percent. It is unclear whether the benefits come from caffeine or the antioxidants found in coffee and tea, but that latte may improve cognition this afternoon and several decades from now.When we rest and dream, memories are sifted through, some discarded, others consolidated and saved. When we don’t sleep, a recent study found, proteins build up on synapses, possibly making it hard to think and learn new things. Furthermore, chronically sleeping poorly (in contrast to not enough) is linked to cognitive decline in old age, although the relationship may not be causal.Largely preventable diseases — such as Type II diabetes, obesity and hypertension — all affect your brain, too. System-wide health concerns have been linked to an increased risk of cognitive decline and memory impairments. Keeping your circulatory system in working order, by, say, avoiding cigarettes and saturated fat, lessens the onslaught of age-related damage to the brain.While overindulging can make the brain sluggish and lead to long-term detriments to your brain, too few calories can also impair brain function. Extreme dieting can cause some diehards to feel stretches of calm — a feeling that may underlie the addiction of anorexia — but many studies have also linked dieting with distraction, confusion and memory impairment.Too much or too little energy throws a kink in the brain’s delicate machinery. A low glycemic diet — high fiber, with moderate amounts of fat and protein — is broken down more slowly in the body than high glycemic foods, such as sweets and white starches. A steady pace of digestion in the gut gives a more reliable flow of energy to the brain, likely optimizing the organ’s long-term health and performance.

Scientists are starting to think that regular aerobic exercise may be the single most important thing you can do for the long-term health of your brain. While the heart and lungs respond loudly to a sprint on the treadmill, the brain is quietly getting fitter with each step, too. For mental fitness, aim for at least 30 minutes of physical activity every other day.

Pig-to-Human Ebola Case Suspected in Philippines

icedragon — Sat, 24 Jan 2009 12:45:31 +0000

January 24, 2009 In the first known case of what may be transmission of the Ebola virus from a pig to a human, a pig handler in the Philippines has tested positive for a strain of the virus, world health officials and the Philippine government announced Friday. But the strain — Ebola Reston — is not known to be dangerous to humans, and the worker, who was infected at least six months ago, is healthy, officials said. The development is worrying, because pigs are mixing vessels for other human and animal viruses, like flu, and because it shows that pigs may also be able to transmit the lethal strains of Ebola. Far more humans are in regular contact with pigs than with apes, monkeys or bats, the other known hosts. But Dr. Juan Lubroth, chief of animal health at the United Nations Food and Agricultural Organization, said that there was “more need to investigate than to worry” and that many unanswered questions remained. Ebola Reston, normally a monkey virus, was first found in pigs last year in the Philippines. Health authorities closed two farms and took blood samples from 6,000 pigs and 50 workers on the farms and in slaughterhouses. Only four pigs and the one worker tested positive, the Philippine health secretary, Francisco Duque, said at a news conference in Manila. Dr. Lubroth said the first pigs tested were very sick, but turned out to have more than one infection, including a virulent reproductive and respiratory syndrome. The Reston virus may not have been what sickened them. “But farmers, of course, would prefer to have pigs without Ebola,” he said. “So we want to do more testing to see what they can do to protect them.” Broader sampling will determine, among other things, whether the disease is more common in pigs and humans than is known, whether it causes fever and how long its incubation period is. Ebola Reston was first found in monkeys from the Philippines that died after arriving at a laboratory in Reston, Va., in 1989. Antibodies to it were found in more than 20 workers in several labs, but it is not known to have caused more than a mild flu. By contrast, the Zaire, Sudan and Bundibugyo strains of Ebola, found in African apes, cause fatal hemorrhagic fever in humans. It is not known how the pigs were infected, but Dr. Lubroth noted that studies in Africa found Ebola viruses in fruit bats. Similar bats live in the Philippines, and fruit bats are thought to have transmitted the deadly Nipah virus to pigs, possibly through their droppings or dead bodies. Even if the Ebola Reston virus can be shared between pigs and people, there is little chance it will mutate to become more lethal, said Dr. Pierre Rollin, acting chief of special pathogens for the Centers for Disease Control and Prevention, who also visited the Philippines for the investigation. “This virus is very stable, not like flu or H.I.V.,” he said. “Previously, when the virus went from primates to humans, it did not change. The identical virus was found in both.” Also, humans do not carry other members of the filovirus family that could mix with it, the way that influenza strains from birds, pigs and humans can swap parts of genes. The infection does suggest that pigs could transmit lethal Ebola, which inspired germ-terror movies like “Outbreak.” Fortunately, Dr. Rollin noted, there are no large pig-farming operations in Sudan, a Muslim country, in rural Congo or in most other places where the fatal strains flourish. “It’s probably a rare event that pigs get infected,” said Dr. Thomas G. Ksiazek, a pathogens specialist at the University of Texas Medical School in Galveston. “It hasn’t led to a past catastrophe. We’d know about a catastrophe.”

New NOF Guidelines and the WHO Fracture Assessment Tool or FRAX

icedragon — Sat, 18 Oct 2008 11:24:09 +0000

The National Osteoporosis Foundation has released a 2008 update to the NOF guidelines last published in 1999. The guidelines, which are evidence based whenever possible, provide recommendations for screening, counseling and treatment of osteoporosis. This update was prompted by the publication of the FRAX, a new fracture risk assessment tool.

FRAX

The World Health Organization has developed this new fracture risk assessment tool to identify individuals at high risk of osteoporotic fracture The current standard, which bases treatment decisions largely on bone mineral density measurement, has proven to be specific, but not sensitive, for the identification of patients at high risk of fracture. Because nearly 50% of postmenopausal women in the community over the age of 50 years who suffer an osteoporotic fracture do not have osteoporosis defined by a BMD test1,2, and because of the limited availability of BMD in many countries, clinical risk factors were added to BMD to identify patients at high risk for osteoporotic fractures3.

A task force from the WHO evaluated the clinical risk factors that predict increased risk of fracture in nearly all of the 12 population cohorts evaluated worldwide. These are:

Age
Sex
Prior fragility fracture after age 50
History of corticosteroid use (5 mg or more for three months or more)
Parental history of hip fracture
Rheumatoid arthritis
Secondary osteoporosis (e.g., type 1 diabetes, osteogenesis imperfecta in adults, longstanding hyperthyroidism, hypogonadism, premature menopause, chronic malabsorption and chronic liver disease)
Current smoker
Alcohol use of greater than 2 units daily (a unit is one medium glass of wine or a glass of beer)
Body Mass Index

FRAX integrates the future osteoporotic fracture risk associated with clinical risk factors with that associated with femoral neck BMD. BMD of the femoral neck (although less data is available, the total hip may also be used in women) tracks in parallel to BMI except at very low BMI, so that BMI may be used when BMD is unavailable. BMI and BMD would not be used in the same individual. The incident rates of fractures are country specific and provide the clinician the 10 year probability of hip fracture and the 10 year probability of major osteoporotic fracture (clinical vertebral, forearm, hip and shoulder). FRAX is currently being validated in additional longitudinal cohort databases. It is anticipated that in the latter half of 2008, the FRAX will be available as a software update for DXA equipment. FRAX is now available to clinicians online at www.shef.ac.uk/FRAX/ 4,5.

The FRAX provides an estimated fracture risk in a given individual but does not identify the level of fracture risk at which treatment should be started (“intervention threshold”). The intervention threshold decision is based on the willingness of a given country or region to pay for the treatments recommended. For example, in the United Kingdom and Sweden osteoporosis treatment is calculated to be cost-effective for a 4% ten year risk of hip fracture, while in the United States osteoporosis treatment is calculated to be cost-effective with ten year risk of a hip fracture of 3%.

Limitations

The FRAX model is a model in progress. It does not include spinal BMD data or bone turnover markers, as bone marker data is not available from many of the countries that contributed longitudinal cohorts to generate the FRAX. Also, FRAX does not include data on BMD measured at the peripheral skeletal sites. Most patients studied for fracture risk were women, and data on ethnic groups in the US are limited. The FRAX cannot be used in patients who have been treated with osteoporosis medications since the probability of fracture may be overestimated. Patients being assessed for osteoporotic fracture risk may not be able to make a treatment decision based on a 10 year probability of a fracture, although the one-year probability would be 10% of a ten-year probability.

The New NOF Guidelines

Role of physicians who evaluate, prevent and treat osteoporosis in postmenopausal women and men age 50 and older:

Counsel on the risk of osteoporosis and related fractures
Check for secondary causes
Advise on adequate calcium and vitamin D intake
Recommend regular weight bearing and muscle strengthening exercise to reduce risk of falls and fractures
Advise avoidance of tobacco smoking and excessive alcohol intake

BMD testing is advised for:

Women age 65 and older
Men age 70 and older
In younger postmenopausal women and men age 50 and older based on risk factor profile
Those with a fracture to determine degree of disease severity

Treatment is recommended for:

Patients with hip or vertebral fracture (clinical or morphometric)
Patients with osteoporosis as defined by T score <=-2.5
Postmenopausal women or men age 50 and older with low bone mass (T score -1 to -2.5, osteopenia) at the femoral neck, total hip, or spine and 10 year hip fracture risk probability >3% or a 10 year all major osteoporosis related fracture probability of >20% based on the U.S. adapted WHO absolute fracture risk model

BMD should be monitored two years after initiating therapy and at two-year intervals thereafter.

Bottom Line:

BMD measurement alone fails to identify a high number of subjects who subsequently develop fractures. The addition of clinical risk factors may indeed be an improvement in risk factor assessment.
While FRAX provides a method to evaluate fracture risk with and without BMD to use for global health, understanding exactly what level of fracture risk is appropriate for therapeutic intervention probably requires additional research.

Hotline Authors: Nancy E. Lane¸ MD, University of California at Davis; Stuart Silverman, MD, Private Practice and Clinical Professor of Medicine, University of California at Los Angeles.

Hotline Editors: Arthur Kavanaugh, MD; Eric Matteson, MD, MPH; Eric Ruderman, MD.

Disclosures: Drs. Lane and Silverman have nothing to disclose. Drs. Kavanaugh, Matteson and Ruderman have nothing to disclose.

The ACR Hotline is provided by the ACR Communications and Marketing Committee as a service to members. This Hotline reflects the views of the author(s) and does not represent a position statement of the American College of Rheumatology.

Siris ES, Brenneman SK, Miller PD, et al. Predictive value of low BMD for 1-year fracture outcomes is similar for postmenopausal women ages 50-64 and 65 and Older: results from the National Osteoporosis Risk Assessment (NORA). J Bone Miner Res. 2004 Aug;19(8):1215-20.
Siris ES, Miller PD, Barrett-Connor E, et al Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 2001 Dec 12;286(22):2815-22.
Cummings SR, Nevitt MC, Browner WS, et al . Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995 Mar 23;332(12):767-73.
Kanis JA, Oden A, Johnell O, et al . The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. 2007 Aug;18(8):1033-46.
Dawson-Hughes B, Tosteson AN, Melton LJ 3rd, , et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA Osteoporos Int. 2008 Feb 22.

Hello world!

icedragon — Sat, 18 Oct 2008 11:19:46 +0000

Welcome to WordPress.com. This is your first post. Edit or delete it and start blogging!