BPA Exposure Higher From Paper Than From Cans
December 2, 2011 — It seems there’s no escaping the chemical bisphenol A (BPA), which is used to make plastics like water bottles and to coat the insides of aluminum cans.
Now a new study shows that BPA is also in a wide variety of paper products, including napkins, toilet paper, tickets, food wrappers, newspapers, and printer paper. “The concentrations are very high in the paper products,” says study researcher Kurunthachalam Kannan, PhD, a research scientist at the New York State Department of Health.
Kannan tested more than 200 paper samples from 15 different types of products.
He found BPA levels in paper that were 100 to 1 million times higher than amounts detected in canned and packaged foods.
The study is published in the journal Environmental Science and Technology. Researchers say that because only a fraction of that is absorbed through the skin, most people probably pick up far less BPA handling paper than they do from their diets. But those amounts may wind up being significant for people like cashiers or printers who have to touch a lot of BPA-tainted paper as part of their jobs.
“We’ve been focused on food, but there could be certain groups of people that could be exposed through other routes and other sources,” says Joseph Braun, PhD, a research fellow at the Harvard School of Public Health, who is studying how BPA may affect kids’ behavior. He was not involved in the latest study.
In Braun’s studies, pregnant women who worked as cashiers had BPA levels that were about 30% higher than pregnant women who had different kinds of jobs.
BPA in Recycled Paper
How did BPA get into paper? Probably recycling, researchers say.
A thin coating of powdered BPA is used on some kinds of heat-sensitive paper, like cash register receipts, shipping labels, and lottery tickets.
Researchers estimate that tossed thermal paper contributes about 33.5 tons of BPA to the environment each year. About 30% of thermal paper winds up being recycled, introducing BPA into many different kinds of items. That’s concerning, researchers say, because BPA is chemically similar to the hormone estrogen. It has been linked to problems with reproduction and sexual development, to behavioral and developmental problems in young children, and to some kinds of cancer.
Experts say such studies are suggestive, but not conclusive. And they insist that there’s no danger from BPA in paper.
“These are trivial exposures,” far below the tolerable safe levels of BPA set by the Environmental Protection Agency, says John Heinze, PhD, executive director of the Environmental Health Research Foundation in Chantilly, Va., a nonprofit organization that does research for the American Chemistry Council, an industry group. “They don’t really raise any concerns for safety. That’s really what their data show.”
How Much BPA Do People Pick Up From Paper?
For the study, researchers tested 103 different thermal receipts collected from supermarkets, banks, libraries, gas stations, and restaurants in seven U. S. cities, South Korea, Vietnam, and Japan. Japan phased out the use of BPA in receipts in 2001.
Researchers also tested 14 other kinds of paper products including flyers, magazines, bus and train tickets, envelopes, newspapers, food wrappers and cartons, airplane boarding passes, luggage tags, printing paper, business cards, napkins, paper towels, and toilet paper.
- Ninety-four percent of the thermal receipts tested positive for BPA, including some receipts that claimed to be BPA-free
- The levels of BPA detected on the receipts were much higher than for other paper products.
- The highest concentration of BPA found among other kinds of paper was in tickets, followed by newspapers.
Researchers then estimated how much paper products might contribute to a person’s total daily BPA exposure.
Cutting BPA Exposure
Based on their models, if an average person handled thermal receipts twice each day, and other kinds of paper five to 10 times a day, they’d get about 2% of their total daily exposure to BPA from paper products.
For cashiers, it was assumed they would touch receipts around 150 times a day, which could contribute as much as 51% of their daily BPA exposure.
Researchers say that if people want to cut their exposure to BPA in paper, they should be careful about how they handle receipts.
If you don’t need one, don’t take it, Kannan says. If you do need a receipt, some retailers will email it. If a hard copy is your only option, head to the sink soon after. “Whenever I touch a thermal receipt paper, immediately I wash my hands,” Kannan says.
For cashiers, he says, wearing gloves would probably help cut the amount of BPA absorbed through the skin.
SOURCES:
Kannan, K. Environmental Science and Technology, Sept. 23, 2011.
Kurunthachalam Kannan, PhD, research scientist, Wadsworth Center, New York State Department of Health, Albany.
Joseph Braun, PhD, research fellow, department of environmental health, Harvard School of Public Health, Boston.
John Heinze, PhD, executive director, Environmental Health Research Foundation, Chantilly.
Diet and Exercise Reduce Pain in Osteoarthritis
From the American College of Rheumatology (ACR) 2011 Annual Meeting: Abstract 722. Presented November 6, 2011.
November 7, 2011 (Chicago, Illinois) — Intensive diet and exercise can slash the amount of pain in older adults with osteoarthritis of the knees and improve function and walking speed, according to a study from researchers at Wake Forest University in Winston-Salem, North Carolina.
The 18-month Intensive Diet and Exercise for Arthritis (IDEA) trial was designed to evaluate the impact of intensive weight loss with or without exercise on disease progression. The results presented here at the American College of Rheumatology 2011 Annual Meeting are the first from the trial, and focus on pain and function only.
Investigators randomized 454 overweight and obese individuals (72% women), with a mean body mass index of 33.6 kg/m2 and an average age of 65.6 years, to 1 of 3 groups: intensive diet designed to achieve weight loss of 10% or more; moderate exercise only (two 15-minute walks and 20 minutes of weight training 3 times a week); or both. Participants met weekly for the first 6 months, and biweekly thereafter. Eighty-eight percent of participants completed the 18-month study.
At the end of the study, participants in the diet-only group lost an average of 9.5% of their baseline weight, and those in the exercise-only group lost an average of 2.2%. The combined diet/exercise group, however, lost an average of 11.4%. None of the participants regressed to baseline levels, even after 18 months.
Although all groups reported less pain at 6 months, the difference between groups was not significant. However, at 18 months, the combined diet/exercise group experienced a 51% reduction in pain, compared with 27% and 28% in the diet-only and exercise-only groups, respectively (P < .0004), said lead author Stephen P. Messier, PhD, director of the J.B. Snow Biomechanics Laboratory at Wake Forest University. Forty percent of those in the combined group rated their pain at 0 or 1 at 18 months, he said, compared with 20% in the exercise-only and diet-only groups.
In addition, participants in the diet/exercise group improved their functional status by 47%, compared with 30% in the diet-only group and 26% in the exercise-only group. The combination group also increased walking speed by 12%, compared with 10% and 6% in the diet-only and exercise-only groups, respectively (P = .004).
“Clearly, our cohort has reversed the trend of declining mobility that is seen in older adults,” Dr. Messier said. In fact, the combination group had a faster walking speed than healthy middle-aged women aged 40 to 62, and one equivalent to that of healthy middle-aged men, he said.
Eric L. Matteson, MD, chair of the Department of Rheumatology at the Mayo Clinic in Rochester, Minnesota, said that the most intriguing finding of the trial is that even patients who did not exercise experienced less pain.
“Both exercise and diet are a great way to improve pain and function,” he said, “but what was really unique in this study was the observation that patients who lost weight had less pain associated with just the weight loss, not even any exercise.” This could be the result of a lower load on the joints, he said, and might enable patients to postpone joint replacement surgery.
It is also possible that patients will be able to reduce the amount of pain medication they take if they lose weight, noted Dr. Messier, something his group hopes to show with additional analysis. “We are hoping from a public health standpoint that medication use goes down,” he said, “and we expect it will.”
The take-home message, he said, is that “clinicians can tell their patients that they will see marked improvement [in pain and function] in 6 months or less.” The fact that significant differences did not appear between the groups until 18 months, however, “underscores the need for long-term studies to detect clinically and statistically meaningful results.”
Dr. Messier and Dr. Matteson have disclosed no relevant financial relationships.
Prenatal BPA Exposure Effect on Emotional Health in Girls
BOSTON—Exposure to the industrial chemical bisphenol A (BPA) before birth may lead to behavior and emotional problems in preschoolers, particularly girls, according to a new study published in the journalPediatrics. The findings add more fire to the already hot debate about healthy hazards associated with BPA exposure.
Researchers at Harvard School of Public Health examined data from 244 mothers and their young children in the Cincinnati area who were taking part in the Health Outcomes and Measures of the Environment Study. They characterized gestational and childhood BPA exposures by using the mean BPA concentrations in maternal (16 and 26 weeks of gestation and birth) and child (1, 2, and 3 years of age) urine samples, respectively. Behavior and executive function were measured by using the Behavior Assessment System for Children 2 (BASC-2) and the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P).
They found 85% of the mothers and 96% of the children had detectable levels of BPA in their urine. There was little difference between the mothers’ in-pregnancy and at-birth levels of BPA. The BPA levels in the children’s urine samples decreased from age 1 to age 3, but they were higher and varied more than their mothers’ levels.
After adjusting for other possible influencers, BPA levels in pregnancy were linked to more hyperactive, aggressive, anxious, and depressed behavior and poorer emotional control and inhibition in the girls, but not the boys.
The researchers concluded gestational BPA exposure affected behavioral and emotional regulation domains at 3 years of age, especially among girls. Clinicians may advise concerned patients to reduce their exposure to certain consumer products, but the benefits of such reductions are unclear.
Soft Drink Consumption Linked to Youth Violence
October 25, 2011 — Public health researchers and nutrition advocates have criticized consumption of carbonated soft drinks because they may fill people up with empty calories, sugar, and caffeine, but new research published online October 24 in Injury Prevention suggests that the drinks also may be linked with, or may be a strong marker for, violent behavior in teenagers.
“This is the first study to suggest such an association,” said David Hemenway, MD, professor of public health and director of the Injury Control Center at the Harvard School of Public Health, Boston, Massachusetts, and the study’s lead author, in an interview with Medscape Medical News.
After controlling for sex, age, race, body mass index, typical sleep patterns, tobacco use, alcohol use, and having family dinners, the investigators found that high consumption of carbonated, nondiet soft drinks was associated with a statistically significant 9% to 15% greater likelihood of engaging in aggressive behaviors. Heavy soft drink use had about the same effect as tobacco and alcohol on violence.
“This is just one study, and it needs to be looked at in more detail.” Dr. Hemenway said. He was reluctant to call it a cause-and-effect relationship, stressing that the exact sugar or caffeine content in the soft drinks was “unknown,” and that “possibly other factors not accounted for in our analysis are related to high soft drink consumption and aggression.”
Dr. Hemenway and coauthors found that teenagers who drank more than five 12-ounce cans of carbonated soft drinks each week were more likely to carry a weapon and commit violence against friends, dates, and siblings. The study also found that the relationship appears to be a dose–response relationship, with the strongest relationships shown for teenagers drinking 14 or more cans per week. Of those adolescents, 42.7% carried a gun or knife, 58.6% were violent toward their peers, 26.9% were violent toward dates, and 45.3% perpetrated violence toward other children in their family. These percentages were significantly higher than in each of the 3 other consumption categories (?1 can, 2 – 4 cans, and 5 – 7 cans in the last 7 days), and there was a statistically significant, linear increase in consumption linked to each of the 4 violence behaviors (P ? .001). Nearly 1 in 3 students were drinking at least 5 cans of carbonated soft drinks.
The study used self-report data from the Boston Youth Survey, a biennial, paper-and-pencil survey of ninth- to twelfth-grade students in Boston public schools to evaluate the effect of soft drink use on aggressive and violent behavior.
The 2725 high school students selected for the study were not representative of adolescents across the United States: 50% were black or multiracial, 33% were Hispanic, 9% were white, and 8% were Asian. Of these groups, only Asians were found to drink much less than the others.
The study was not able to show a relationship between soft drink consumption and obesity, which has been shown in other studies. Heavy soft drink use was also associated with other dimensions; for example, getting insufficient sleep and using alcohol and tobacco within the past 30 days.
Dr. Hemenway acknowledged several study limitations, including the self-report of the data, the generalizability to other adolescents, and the lack of information on the sodas themselves. In the discussion section, the authors write that a “direct-cause-and effect relationship between soft drink consumption and aggression is one possibility,” adding that “various ingredients, including carbonated water, high fructose corn syrup, aspartame, sodium benzoate, phosphoric or citric acid, and often caffeine…might affect behaviour.”
The author introduces his study by reminding readers of the “Twinkie defense,” which was used successfully to reduce Dan White’s conviction from homicide to manslaughter for the 1978 killing of San Francisco City District Supervisor Harvey Milk and Mayor George Moscone.
“I am totally not convinced,” noted Marion Nestle, PhD, MPH, Pauline Goddard professor of nutrition, food policies, and public health at New York University School of Medicine, New York City, in an email to Medscape Medical News.” As I said, I’m no fan of sodas, but [it] defies common sense.”
Dr. Nestle also was not impressed with the study design. She noted: “This looks like a ‘tracking’ study to me. I don’t see how the study can conclude anything specific about soft drinks except guilt by association.” She added that “poor kids drink more soft drinks than rich kids, and they are marketed to more aggressively.
“If it turns out that alcohol and junk food diets can be linked to negative behaviors,” she said, “[s]oda companies will reap what they sowed when they focused so much marketing on low-income, minority communities.”
The study was supported by the US Centers for Disease Control and Prevention. It was externally peer reviewed. The authors and Dr. Nestle have disclosed no relevant financial relationships.
Injury Prev. Published online October 24, 2011. Abstract
Why Vitamin K2 is So Important for Your Kids
Great new for parents who buy Kids Potential …
We added Natural Dairy & Casein-Free Vitamin K2, as MK-7, to Kids Potential for healthy bone density to help them develop healthy, strong bones beginning early in life. Here is a re-post of relevant scientific research that gives you some idea of why Vitamin K2 is an important nutrient for your growing children.
Learn more here: Kids Potential and www.mykidspotential.com.
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Findings of a new study published in British Journal of Nutrition 2009 by van Summeren and colleagues demonstrated that even modest supplementation with menaquinone-7 in children increases activation of osteocalcin, the bone-building protein; and in that way supports healthy bone growth and development. This is an important finding as the greater bone mineral established during childhood and early adult years, culminating in peak bone mineral density around 30 years of age, allows for better maintenance of bone health as we age and lose bone mass.
The present study is a double-blind randomized placebo-controlled study examining the effect of 45 mcg natural vitamin K2 as menaquinone-7 (MK-7) on the circulating levels of the vitamin K-dependent protein Osteocalcin. Active osteocalcin is required for bone-building cells (osteoblasts) to optimally utilize calcium for building and maintaining a healthy bone matrix. 8 weeks of supplementation in healthy prepubertal children increased blood levels of vitamin K2 as MK-7 and significantly increased the amount of active osteocalcin.
According to Professor Cees Vermeer at the VitaK research center, “Non-supplemented people are generally insufficient in vitamin K. It has been demonstrated that children are far more vitamin K deficient than adults. We explain this by the rapid growth of their bones and consequently the high vitamin K demand by the bones for the production of osteocalcin. The present study is the first one to demonstrate that increased vitamin K intake by supplement improves the osteocalcin activity in children. The next step must be that also an effect of MK-7 on bone strength or fracture risk is demonstrated in this age group. There is a growing awareness that maximizing bone strength at childhood is an important strategy to prevent osteoporosis at later age.”
Osteocalcin – the potent protein
Osteocalcin is a protein responsible for utilization of calcium within bone tissue – it has the ability to bind calcium to the matrix of bones, which makes them stronger and less susceptible to fractures. Without sufficient amounts of vitamin K in the diet, or in cases of Vitamin K deficiency, inactive osteocalcin is not able to bind calcium properly, and thus the bones weaken and become fragile.
Strong bones – best investment for the future
Children have the greatest requirement for active osteocalcin and thus for K vitamins because bone tissue grows and develops most intensively during childhood and adolescence. The higher peak mass young bones achieve, the lower the risk of osteoporotic changes in the elderly. Hence, the optimal pubertal status of bone is important to prevent disorders in later life.
Benefits scientifically proven
Results of the new study clearly confirm outcomes of previous laboratory experiments, population-based (i.e., epidemiological) studies and clinical trials that have tightly linked better vitamin K status in children to the achievement of a healthy, strong bone-structure. Simplified, improving vitamin K status in children results in stronger and denser bones. Additional K vitamins intake might also improve bone geometry and positively influence gain in bone mass. That contributing effect has been recently reported by O’Connor et al , who, while conducting a study in a cohort of 223 healthy girls (11-12 years old), found better K vitamin status related to higher bone mineral density.
Warfarin, a commonly prescribed blood-thinning medication, inhibits vitamin K activity. A study of children with long-standing vitamin K deficiency induced by this drug were shown to have a significantly reduced bone mass, which illustrates the potential consequences of K vitamins deficiency in growing bones.
Eat Your Greens, Change Your Genes
You might not be stuck with the genes your parents gave you. New research fromMcMaster and McGill universities found that consumption of fruit and raw vegetables modified a gene called 9p21, the strongest marker for heart disease.
The study involved more than 27,000 subjects from five ethnicities—European, South Asian, Chinese, Latin American and Arab—and the affect that their diets had on the effect of the 9p21 gene. The results suggest that individuals with the high-risk genotype who consumed a prudent diet, composed mainly of raw vegetables, fruits and berries, had a similar risk of heart attack to those with the low-risk genotype.
“We know that 9p21 genetic variants increase the risk of heart disease for those that carry it,” said Jamie Engert, joint principal investigator of the study and researcher in cardiovascular diseases at the Research Institute of the McGill University Health Centre (RI-MUHC) and associate member in the Department of Human Genetics at McGill University. “But it was a surprise to find that a healthy diet could significantly weaken its effect.”
“Our research suggests there may be an important interplay between genes and diet in cardiovascular disease,” said the study’s lead author Ron Do, who conducted this research as part of his PhD at McGill and is now based at the Center for Human Genetics Research at the Massachusetts General Hospital in Boston. “Future research is necessary to understand the mechanism of this interaction, which will shed light on the underlying metabolic processes that the 9p21 gene is involved in.”
The results of the study are published in the current issue of PLoS Medicine.
How Autogenous Vaccine Can Turn Off Peanut Allergy
CHICAGO—By attaching peanut proteins to blood cells and reintroducing them into mice with peanut allergies, researchers at Northwestern University Feinberg School of Medicine found they were able to turn off the allergic reaction.
“We think we’ve found a way to safely and rapidly turn off the allergic response to food allergies,” said Paul Bryce, PhD, an assistant professor of medicine in the division of allergy-immunology at Northwestern University Feinberg School of Medicine. “Their immune system saw the peanut protein as perfectly normal because it was already presented on the white blood cells. Without the treatment, these animals would have gone into anaphylactic shock.”
Researchers also found this approach has a second benefit: It creates a more normal, balanced immune system by increasing the number of regulatory T cells, immune cells important for recognizing the peanut proteins as normal.
“T cells come in different ‘flavors’” Bryce said. “This method turns off the dangerous Th2 T cell that causes the allergy and expands the good, calming regulatory T cells. We are supposed to be able to eat peanuts. We’ve restored this tolerance to the immune system.”
Bryce thinks more than one protein can be attached to the surface of the cell and, thus, target multiple food allergies at one time.
In the second part of the study, the researchers used the same approach with an egg protein, which was to provoke an immune response –- similar to an asthma attack — in the lungs. They attached the proteins to white blood cells and infused the cells back into the mice. When the mice inhaled the asthma-provoking egg protein, their lungs didn’t become inflamed.
Cheaper Natural Smoking Cessation Assistance
Reuters (09/29/11) Emery, Gene
Cytisine, an extract from the seeds of the Golden Rain acacia that was first marketed in Bulgaria in 1964, can give smokers an inexpensive assist in kicking the habit, according to the first large modern study of the drug, published in the New England Journal of Medicine.
In the test on 740 volunteers, 8.4 percent of those who were given cytisine for 25 days stayed off cigarettes for one year, compared with 2.4 percent in the placebo group.
That success rate is comparable to treatment with nicotine patches and other anti-smoking drugs like varenicline (Chantix) and bupropion (Zyban), but costs much less.
A month of cytisine pills, sold in Central and Eastern Europe under the brand name Tabex, costs about $15 in Poland and $6 in Russia.
Nicotine patches and pills to stop smoking typically sell for more than $100 per treatment, depending on the country.
The drug is not approved in the United States, Japan or Western Europe.
Data Show Drug Deaths Outnumber Traffic Fatalities
From the L A Times
Drug deaths now outnumber traffic fatalities in U.S., data show
Fueling the surge are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol.
By Lisa Girion, Scott Glover and Doug Smith, Los Angeles Times
Propelled by an increase in prescription narcotic overdoses, drug deaths now outnumber traffic fatalities in the United States, a Times analysis of government data has found.
Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide, according to preliminary data from the U.S. Centers for Disease Control and Prevention.
While most major causes of preventable death are declining, drugs are an exception. The death toll has doubled in the last decade, now claiming a life every 14 minutes. By contrast, traffic accidents have been dropping for decades because of huge investments in auto safety.
Public health experts have used the comparison to draw attention to the nation’s growing prescription drug problem, which they characterize as an epidemic. This is the first time that drugs have accounted for more fatalities than traffic accidents since the government started tracking drug-induced deaths in 1979.
Fueling the surge in deaths are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol. Among the most commonly abused are OxyContin, Vicodin, Xanax and Soma. One relative newcomer to the scene is Fentanyl, a painkiller that comes in the form of patches and lollipops and is 100 times more powerful than morphine.
Such drugs now cause more deaths than heroin and cocaine combined.
“The problem is right here under our noses in our medicine cabinets,” said Laz Salinas, a sheriff’s commander in Santa Barbara, which has seen a dramatic rise in prescription drug deaths in recent years.
Overdose victims range in age and circumstance from teenagers who pop pills to get a heroin-like high to middle-aged working men and women who take medications prescribed for strained backs and bum knees and become addicted.
A review of hundreds of autopsy reports in Southern California reveals one tragic demise after another: A 19-year-old Army recruit, who had just passed his military physical, took a handful of Xanax and painkillers while partying with friends. A groom, anxious over his upcoming wedding, overdosed on a cocktail of prescription drugs. A teenage honors student overdosed on painkillers her father left in his medicine cabinet from a surgery years earlier. A toddler was orphaned after both parents overdosed on prescription drugs months apart. A grandmother suffering from chronic back pain apparently forgot she’d already taken her daily regimen of pills and ended up double dosing.
Many died after failed attempts at rehab — or after using one too many times while contemplating quitting. That’s apparently what happened to a San Diego woman found dead with a Fentanyl patch on her body, one of five she’d applied in the 24 hours before her death. Next to her on the couch was a notebook with information about rehab.
The seeds of the problem were planted more than a decade ago by well-meaning efforts by doctors to mitigate suffering, as well as aggressive sales campaigns by pharmaceutical manufacturers. In hindsight, the liberalized prescription of pain drugs “may in fact be the cause of the epidemic we’re now facing,” said Linda Rosenstock, dean of the UCLA School of Public Health.
In some ways, prescription drugs are more dangerous than illicit ones because users don’t have their guard up, said Los Angeles County Sheriff’s Sgt. Steve Opferman, head of a county task force on prescription drug-related crimes. “People feel they are safer with prescription drugs because you get them from a pharmacy and they are prescribed by a doctor,” Opferman said. “Younger people believe they are safer because they see their parents taking them. It doesn’t have the same stigma as using street narcotics.”
Lori Smith said she believes that’s what her son might have been thinking the night he died six months shy of his 16th birthday. Nolan Smith, of Aliso Viejo, loved to surf, sail and fish with his brother and father. He suffered from migraines and anxiety but showed no signs of drug abuse, his mother said.
The night before he died in January 2009, Nolan called his mother at work, asking for a ride to the girls basketball game at Aliso Niguel High School. Lori told him she couldn’t get away.
When Nolan didn’t come home that evening, his parents called police and his friends. His body was found the next morning on a stranger’s front porch.
A toxicology test turned up Zoloft, which had been prescribed for anxiety, and a host of other drugs that had not been prescribed, including two additional anti-anxiety drugs, as well as morphine and marijuana.
All investigators could give the family were theories.
“They said they will have parties where the kids will throw a bunch of pills in a bowl and the kids take them without knowing what they are,” Lori said. “We called all of his friends, but no one would say they were with him. But he must have been with someone. You just don’t do that by yourself.”
The triumph of public health policies that have improved traffic safety over the years through the use of seat belts, air bags and other measures stands in stark contrast to the nation’s record on prescription drugs. Even though more people are driving more miles, traffic fatalities have dropped by more than a third since the early 1970s to 36,284 in 2009. Drug-induced deaths had equaled or surpassed traffic fatalities in California, 22 other states and the District of Columbia even before the 2009 figures revealed the shift at the national level, according to the Times analysis.
The Centers for Disease Control collects data on all causes of death each year and analyzes them to identify health problems. Drug-induced deaths are mostly accidental overdoses but also include suicides and fatal diseases caused by drugs.
The CDC’s 2009 statistics are the agency’s most current. They are considered preliminary because they reflect 96% of death certificates filed. The remaining are deaths for which the causes were not immediately clear.
Drug fatalities more than doubled among teens and young adults between 2000 and 2008, years for which more detailed data are available. Deaths more than tripled among people aged 50 to 69, the Times analysis found. In terms of sheer numbers, the death toll is highest among people in their 40s.
Overdose deaths involving prescription painkillers, including OxyContin and Vicodin, and anti-anxiety drugs such as Valium and Xanax more than tripled between 2000 and 2008.
The rise in deaths corresponds with doctors prescribing more painkillers and anti-anxiety medications. The number of prescriptions for the strongest pain pills filled at California pharmacies, for instance, increased more than 43% since 2007 — and the doses grew by even more, nearly 50%, according to a review of prescribing data collected by the state.
Those prescriptions provide relief to pain sufferers but also fuel a thriving black market. Prescription drugs are traded on Internet chat rooms that buzz with offers of “vikes,” “percs” and “oxys” for $10 to $80 a pill. They are sold on street corners along with heroin, marijuana and crack. An addiction to prescription drugs can be costly; a heavy OxyContin habit can run twice as much as a heroin addiction, authorities say.
On a recent weekday morning, Los Angeles County undercover sheriff’s deputies posing as drug buyers easily purchased enough pills to fill a medicine cabinet on a sidewalk a few blocks south of Los Angeles City Hall.
The most commonly abused prescription drug, hydrocodone, also is the most widely prescribed drug in America, according to the U.S. Drug Enforcement Agency. Better known as Vicodin, the pain reliever is prescribed more often than the top cholesterol drug and the top antibiotic.
“We have an insatiable appetite for this drug — insatiable,” Joseph T. Rannazzisi, a top DEA administrator, told a group of pharmacists at a regulatory meeting in Sacramento.
In April, the White House Office of National Drug Control Policy announced initiatives aimed at stanching prescription drug abuse. The plans include a series of drug take-back days, modeled after similar programs involving weapons, in which consumers are encouraged to turn leftover prescription drugs in to authorities. Another initiative would develop voluntary courses to train physicians on how to safely prescribe pain drugs, a curriculum that is not widely taught in medical schools.
Initial attempts to reverse the trend in drug deaths — such as state-run prescription drug-monitoring programs aimed at thwarting “doctor-shopping” addicts — don’t appear to be having much effect, experts say.
“What’s really scary is we don’t know a lot about how to reduce prescription deaths,” said Amy S.B. Bohnert, a researcher at the University of Michigan Medical School who is studying ways to lower the risk of prescription drugs.
“It’s a wonderful medical advancement that we can treat pain,” Bohnert said. “But we haven’t figured out the safety belt yet.”
Reason Why Elderly May be at Cardiovascular Risk
ELDERLY MAY BE AT CARDIOVASCULAR RISK DUE TO VITAMIN B12 DEFICIENCY
Researchers have found that almost five percent of Canadians aged 6 to 79 are vitamin B12 deficient, suggesting a possible cardiovascular risk in Canada and the US among the elderly, a group at greater risk of B12 malabsorption. (Deficiencies of both vitamin B12 and folate are linked with high levels of the amino acid homocysteine, a powerful risk factor for cardiovascular disease. Metabolism of vitamin B12 and folate is interdependent; if folate is sufficient, B12 deficiency alone can cause high homocysteine. After widespread folate fortification in both countries, the researchers examined folate, vitamin B12, and homocysteine levels.)
Folate levels were sufficient, but B12 levels were deficient in 4.6 percent of the general population, confirmed by high homocysteine levels in these individuals. The researchers concluded that in folate-fortified populations, including Canada and the US, vitamin B12 deficiency is a major cause of high homocysteine and a key factor in cardiovascular disease. The deficiency and cardiovascular risk would be much greater among the elderly. Released September 7, 2011 by the American Journal of Clinical Nutrition, this study will appear in a future issue. It is available now at http://bit.ly/r2kulz.
Vitamin C Linked to Lower Blood Pressure
VITAMIN C LEVELS LINKED TO LOWER BLOOD PRESSURE
A study has concluded that a higher intake of fruits and vegetables, for which a greater blood concentration of vitamin C was used as an indicator, decreases the risk of developing high blood pressure by up to 22 percent for those in the top quarter of vitamin C levels.
The large epidemiological study adjusted for numerous potentially confounding factors, such as age, sex, body mass, alcohol consumption, smoking, blood pressure medications, and even vitamin C supplementation. In other words, the link between higher vitamin C levels and reduced blood pressure risk was found whether the subjects took supplements or not, so long as the vitamin C concentrations were high. Only the systolic blood pressure reading (the number on the top) was included in the study.
This research will not be published until the September 2011 issue of the journal Hypertension, but it is available online now at http://bit.ly/qZlsRX with subscription or access fee.
How 15 Minutes/Day Can Impact Your Life
The minimal amount of physical activity to reduce mortality risk is 15 minutes a day of moderate-intensity exercise, according to the results of a prospective cohort study reported online August 16 in The Lancet.
“Exercising at very light levels reduced deaths from any cause by 14 percent,” said senior author Xifeng Wu, MD, PhD, professor and chair of the University of Texas MD Anderson Cancer Center Department of Epidemiology, in a news release. “The benefits of exercise appear to be significant even without reaching the recommended 150 minutes per week based on results of previous research.”
The study cohort consisted of 416,175 persons in Taiwan (199,265 men and 216,910 women) who were evaluated between 1996 and 2008 in a standard medical screening program. Average duration of follow-up was 8.05 ± 4.21 years. Participants were categorized according to the amount of weekly exercise self-reported on a questionnaire as inactive, low, medium, high, or very high activity. For each group, life expectancy and hazard ratios (HRs) were calculated for mortality risk, with use of the inactive group as the standard.
The average amount of exercise in the low-volume activity group was 92 minutes per week (95% confidence interval [CI], 71 – 112) or 15 ± 18 minutes per day. Risk for all-cause mortality was 14% lower (HR, 0.86; 95% CI, 0.81 – 0.91), and life expectancy was 3 years longer in the low-volume activity group vs the inactive group.
Beyond the minimal amount of 15 minutes of daily exercise, each additional 15 minutes was associated with a further reduction in all-cause mortality risk by 4% (95% CI, 2.5 – 7.0) and in all-cancer mortality risk by 1% (95% CI, 0.3 – 4.5). These benefits of exercise were seen in all age groups, in both sexes, and in persons at risk for cardiovascular disease. Compared with individuals in the low-volume group, inactive persons had a 17% increased risk for mortality (HR, 1.17; 95% CI, 1.10 – 1.24).
“15 min a day or 90 min a week of moderate-intensity exercise might be of benefit, even for individuals at risk of cardiovascular disease,” the study authors write.
Limitations of this study include observational design with possible confounding, reliance on self-report to determine exercise amount, lack of generalizability to other populations, and possible loss to follow-up.
In an accompanying editorial, Anil Nigam and Martin Juneau, from Montreal Heart Institute and Université de Montréal in Quebec, Canada, note that “this is the first observational study of this size to report important and global health benefits at such a low volume of leisure-time physical activity with this degree of precision.”
“The knowledge that as little as 15 min per day of exercise on most days of the week can substantially reduce an individual’s risk of dying could encourage many more individuals to incorporate a small amount of physical activity into their busy lives,” Drs. Nigam and Juneau write. “Governments and health professionals both have major roles to play to spread this good news story and convince people of the importance of being at least minimally active.”
The exercise project was funded by the Taiwan Department of Health Clinical Trial and Research Center of Excellence, and the Taiwan National Health Research Institutes supported this study. The study authors and editorialists have disclosed no relevant financial relationships.
Lancet. Published online August 16, 2011.
Another Benefit of Vitamin D
VITAMIN D PROTECTS AGAINST MORE AGGRESSIVE COLON CANCERS
Researchers have found that cholecalciferol, or vitamin D3, acts on a specific biological pathway that results in a protective effect against more aggressive forms of colon cancer. Evidence that vitamin D inhibits the growth of colon cancer cells is not new, but this study found that vitamin D slows down the action of beta-catenin, a key protein in the carcinogenic transformation process that can cause colon cancers to develop as the more aggressive type.
The study was conducted on mice and also on human colon cancer cells. The scientists reported that treatment with vitamin D in the initial stages of colon cancer could prevent development of aggressive cancers and save lives, but they stressed that this would not be useful in the advanced stages.
Vitamin D is available from some foods such as oily fish (salmon, mackerel, sardines, and tuna), from direct sunlight on exposed skin, and from supplement pills or cod liver oil.
The sole vegan source is UV-irradiated mushrooms.
This study was just published electronically in the online journal PLoS, and the full text is now available at http://bit.ly/mYUAJ0 without cost.
Is that Statin Drug Necessary?
Tens of thousands of patients at low risk of heart attacks or strokes could be taking statin heart drugs needlessly, a study published in Britain says. The study published in The Lancet medical journal is the latest suggesting too many people are taking cholesterol-lowering statin drugs who show no evidence of coronary artery calcium, The Daily Telegraph reported Friday.As many as 7 million middle-aged and older people in England are thought to take statins at a cost of $825 million a year to the National Health Service, the Telegraph said. Tens of thousands of patients at low risk of heart attacks or strokes could be taking statin heart drugs needlessly, a study published in Britain says.
The study published in The Lancet medical journal is the latest suggesting too many people are taking cholesterol-lowering statin drugs who show no evidence of coronary artery calcium, The Daily Telegraph reported Friday.
As many as 7 million middle-aged and older people in England are thought to take statins at a cost of $825 million a year to the National Health Service, the Telegraph said.
Researchers said the findings have important public health implications and significant cost savings could be realized if cholesterol-lowering drugs were prescribed only for those who would genuinely benefit.
“The greatest challenge for preventive medicine is identifying people who are at highest risk of heart disease and who should be given drugs, particularly statins, to reduce that risk,” said Peter Weissberg, medical director for the British Heart Foundation.
Is Your Glass of Water A Cocktail of This…?
Source: Chicago Tribune
Aug. 06–Trace amounts of sex hormones, prescription drugs, flame retardants and herbicides are being detected in treated drinking water pumped to more than 7 million people in Chicago and its suburbs.
In the latest round of testing prompted by a 2008 Tribune investigation, city officials discovered that more than two dozen pharmaceutical drugs and other unregulated chemicals pass through Chicago’s massive treatment plants.
Little is known about potential health effects from drinking drug-contaminated water, but scientists and regulators increasingly are concerned about long-term exposure, even at very low levels.
“We need to start addressing the cumulative effects that these low-dose exposures could be having on people,” said Thomas Burke, associate dean of the Johns Hopkins Bloomberg School of Public Health.
“There are no quick solutions,” said Burke, who chaired a National Academy of Sciences committee that called for a dramatic overhaul of the way the U.S. regulates toxic chemicals. “But we need a new approach that is more responsive to emerging science.”
Like other cities, Chicago must notify the public if its drinking water contains regulated contaminants, including lead, pesticides and harmful bacteria. There is no such requirement if pharmaceuticals and other unregulated substances are detected.
Annual water quality reports mailed last month to people in Chicago and the suburbs noted that the city is testing for substances that aren’t on the U.S. Environmental Protection Agency’s list of regulated contaminants. A list of results obtained by the Tribune is dated April 11 but wasn’t posted on the city’s website until after the newspaper asked for it last week.
City officials were prompted to start testing for the substances after the Tribune found trace amounts of pharmaceuticals, residue from personal care products and unregulated industrial chemicals in local tap water. Substances found in the city’s latest tests include the sex hormones testosterone and progesterone; gemfibrozil, a prescription cholesterol-fighting drug; and DEET, the active ingredient in bug spray.
The tests also found perfluorooctane sulfonate, an ingredient in Scotchgard stain-fighting coatings; bisphenol A, a hormone-like plastics additive; and tris (2-butoxyethyl) phosphate, a flame retardant chemical.
“Our very awareness of trace amounts of these chemicals comes in large part because we are aggressively conducting research on water quality and safety,” said Tom LaPorte, a spokesman for the Chicago Department of Water Management.
Drugs end up in drinking water after people take medicines and residue passes through their bodies down the toilet. Conventional sewage and water treatment filters out some of the substances, or at least reduces the concentrations, but studies have found that small amounts still get through.
Although treated sewage from the Chicago area drains away from Lake Michigan, more than 300 other cities discharge treated waste and untreated sewage overflows into the lake and its tributaries, according to the EPA.
“Exposure to some of these chemicals … is cause for consternation for people and concern over fish and wildlife impacts,” said Rebecca Klaper, a researcher at the University of Wisconsin-Milwaukee who studies the Great Lakes.
The EPA’s position is that it doesn’t yet have enough evidence to limit pharmaceuticals and many other unregulated chemicals in drinking water. Water officials say not enough is known to justify spending millions of taxpayer dollars to upgrade treatment plants.
WHAT YOU CAN DO
Drug disposal
The detection of pharmaceuticals in water has prompted new advice about how to properly dispose of unused medicine. The Illinois EPA recommends taking it to collection events for household hazardous waste. If that is not practical, you can place unused drugs in the trash after grinding them up and mixing them with coffee grounds or cat box filler so they can’t be stolen. Questions? Email the agency at EPA.Meds.Mail@Illinois.gov. (This e-mail address is being protected from spambots. You need JavaScript enabled to view it .)
Vitamin D Deficiency Raises Risk of Metabolic Syndrome
VITAMIN D DEFICIENCY RAISES RISK OF METABOLIC SYNDROME
A study has found that those with low vitamin D levels are 70 percent more likely to have metabolic syndrome.
Also, those with low levels of vitamin D were 2.63 times as likely to be obese in the abdomen; 26 percent more likely to have low levels of HDL (good) cholesterol; 22 percent more likely to have high blood glucose (blood sugar) levels; 46 percent more likely to have high or abnormal blood triglycerides; and 43 percent more likely to have high or abnormal blood pressure readings.
The results of this research on Asian volunteers in Kuala Lumpur confirm similar findings regarding vitamin D deficiencies among non-Asian Westerners.
This study was published in a supplement of the August 2011 issue of the Journal of Epidemiology and Community Health and is available now online at http://bit.ly/oGmSXa with subscription or access fee.
Latest Research on Alzheimer’s Prevention
VITAMIN D SUFFICIENCY
Researchers conclude that vitamin D sufficiency helps remove amyloid-beta plaque from the aging brain, across the blood-brain barrier, helping to prevent the excessive buildup that causes Alzheimer’s disease.
(The buildup in the brain, of amyloid-beta plaque is ordinarily controlled by transporter proteins and vitamin D. Although levels of these protein transporters increase with age, production tends to fail eventually. Low levels of vitamin D have been linked with age-related declines in memory and cognition, and with an increased risk of Alzheimer’s.)
The team found that vitamin D injections in mice appear to help regulate protein expression and cell signaling, which helps prevent plaque buildup and the onset of Alzheimer’s disease and dementia. The implication is that maintaining sufficient vitamin D levels with advancing age may provide some preventive benefit, and a potential therapy, for these brain disorders.
This newly released study will be published in a future issue of the journal, Fluids and Barriers of the CNS. It is available early at http://bit.ly/nmFQyC without fee.
GRAPESEED POLYPHENOLS
A new study found that grapeseed polyphenol, a natural antioxidant, suppresses the creation of a specific form of beta-amyloid peptide – a substance in the brain long known to cause the neurotoxicity associated with Alzheimer’s disease – and therefore confirms, according to the researchers, previous research suggesting that grapeseed polyphenol may be an effective treatment for people at risk for the disease to prevent its development or retard its progression.
The authors stress that for grape-derived polyphenols to be effective, it will be necessary to find a biomarker for those at risk, although it may also be beneficial for those in the early stages of the disease. The study is significant because it is the first to examine the effect of this substance on these destructive peptides, illustrating the mechanism behind the apparent protective benefit, and because it was conducted on living subjects, namely mice. However, research is now being conducted to confirm that the results hold true for humans. The full-text of this just-released study is not yet available but will be published in a future issue of the Journal of Alzheimer’s Disease.
Can Red Wine & Dark Chocolate Offset the Effects of a Sedentary Lifestyle?
COMPOUND MIGHT OFFSET SEDENTARY LIFESTYLE
A study has suggested that resveratrol, a compound found in small amounts in cocoa powder, boiled peanuts, and red wine, may offset the negative health effects – such as insulin resistance and loss of bone mass – stemming from a lack of exercise in a sedentary lifestyle.
Resveratrol is an antioxidant substance often reported by the mainstream media to be a major component of red wine; in fact, wine contains only trace amounts. Its cardiovascular health benefits are controversial and the subject of ongoing research.
The researchers tested resveratrol on rats that lived in an environment mimicking the weightless of space, which has negative health effects on astronauts. The rats provided resveratrol managed to avoid the insulin resistance and loss of bone mineral density that affected those sedentary rats not fed resveratrol. (Insulin resistance is linked to diabetes risk.) Resveratrol is found in supplements, which are often made from Japanese knotweed, and in small amounts in cocoa powder, red wine, and boiled peanuts. This study was released June 29, 2011 and will appear in a future issue of The FASEB Journal. It is online now at http://bit.ly/lLx6fj.
Study: Green Tea Lowers Cholesterol
GREEN TEA LOWERS CHOLESTEROL
Researchers have completed a comprehensive meta-analysis and found that drinking green tea or taking green tea extract lowered blood levels of total cholesterol, reduced levels of low-density-lipoprotein (LDL or bad) cholesterol, but did not have any effect on levels of high-density-lipoprotein (HDL or good) cholesterol. LDL cholesterol is often referred to by the media as bad cholesterol because some studies have associated higher levels of these fat particles in the blood with health problems and cardiovascular disease.
The effect of green tea on cholesterol has been controversial. The combined results of 14 trials involving a total of 1,136 test subjects showed an average reduction in total cholesterol of 7.20 mg/dL, and an average reduction in LDL cholesterol of 2.19 mg/dL, both of which are considered statistically significant.
This study was released June 29, 2011 by the American Journal of Clinical Nutrition and will appear in a future print issue. It is accessible online now at http://bit.ly/l4mYEW to subscribers or those who pay the access fee.
Reference:
Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials Am J Clin Nutr 2011 ajcn.010926; First published online June 29, 2011.
New Hope for Type I Diabetics (Juvenile)
CHEMICAL MADE BY PANCREAS MAY CURE TYPE 1 DIABETES
A study has found that injection of gamma-aminobutyric acid (GABA), a compound that is produced in non-diabetic people by the same pancreatic cells (islet beta cells) that normally make insulin, can prevent and even reverse type 1 diabetes in mice. (In type 1 diabetes, formerly known as juvenile diabetes, the immune system attacks and destroys the beta cells in the pancreas that make and secrete insulin, leaving the patient with little or no insulin. GABA is also known as a brain messenger, or neurotransmitter, but its role in the pancreas was unknown.)
This may be an especially effective therapy and prevention for type 1 diabetes because GABA was found both to regenerate insulin-producing beta cells, and to prevent destruction of those cells by the immune system. This treatment would need human trials before it could be considered a new treatment for type 1 diabetes.
This study was released June 27, 2011 and will appear in a future issue of the Proceedings of the National Academy of Science. It is available online now at http://bit.ly/l0YWg9 with subscription or fee.
How Many Commercials Do Kids See a Year?
How much TV do your kids watch?
If you don’t know, you might want to find out, say experts, since the time children spend in front of a TV or computer screen can have a profound effect on their physical and developmental health.
In a new policy statement on the role of media on obesity, the American Academy of Pediatrics’ (AAP) Council on Communications and Media warns parents that TV watching doesn’t just make children more sedentary, but also influences their eating habits, which in turn has consequences for their health. In other words, it’s not just that TV watching encourages youngsters to be less physically active, but it also exposes them to food advertisements that contribute to develop poor eating habits that can set kids up for health problems as adults.
“We created a perfect storm between media use, junk and fast food advertising, and physical inactivity,” says Dr. Victor Strasburger, professor of pediatrics at the University of New Mexico School of Medicine and member of the AAP’s Council. “We created a situation where we now have more overweight and obese adults in the U.S, than underweight and normal weight adults; it’s become an urgent public health problem.”
The policy statement highlights the fact that the harms of TV viewing go beyond promoting inactivity. More studies have shown that children who spend more time in front of the tube are more likely to eat higher-calorie foods, drink sugared sodas and grow up to be overweight adults. In a U.K. study that followed children over 30 years into adulthood, for every additional hour of TV youngsters watched on weekends at age five, their risk of being obese as adults rose by 7%. And in some cases, it doesn’t even take that long for the extra pounds to accumulate: a Japanese study found that children who watched more TV at age three were more likely to be overweight at age six.
The culprit: advertising for unhealthy foods.
The average American child sees nearly 8,000 commercials on TV for food and beverages, and only 165 of these are for nutritious options like fruits and vegetables. “Clearly eating behavior changes if you watch a lot of TV,” says Strasburger. “You tend to snack more, eat more unhealthy food and eat more calories if you eat in front of the TV set.”
What can parents do?
- Limiting TV time to no more than two hours a day can help, says the AAP committee.
- Another important step toward breaking the TV-obesity link is to make sure that children don’t have TV sets or Internet connections in their bedrooms.
- Parents should also watch television with their kids, so they can educate them about commercials and learn to distinguish healthy from unhealthy foods.
“Media such as television is the most important and under-appreciated influence on children’s development and behavior,” says Strasburger. “Media affect virtually every concern that parents and pediatricians have about their kids, whether it’s obesity, sex, drugs or school performance. When kids spend up to seven hours a day watching television or on the computer, it’s time to acknowledge that influence and spend money on researching how we can maximize the good effects of media and minimize its bad effects.”
Even Diet Soda Induces Weight Gain in Elderly
June 24, 2011 (San Diego, California) — The perception that diet soft drinks are a benign alternative to highly sweetened beverages might be dangerously wrong, according to the results of the San Antonio Longitudinal Study of Aging, which were reported here at the American Diabetes Association 71st Scientific Sessions.
Diet soft drinks have long been thought to be a healthier alternative to their sugary counterparts; however, past reports have linked increased incidence of obesity, metabolic syndrome, and diabetes to the frequent intake of diet soft drinks.
In the study presented, Sharon P. Fowler, MPH, from the University of Texas Health Science Center at San Antonio, and colleagues examined the effect of the long-term consumption of diet soft drinks by a population of individuals 65 to 74 years of age (n = 474).
At baseline, measures of height, weight, and waist circumference were recorded, as was diet soft drink intake. Three additional exams of the study subjects were conducted over an average follow-up of just over 3.5 years (the study was conducted over a 9-year period).
When the results of these observations were compared with those from subjects who did not drink diet soft drinks, the differences were striking. Overall, consumers of diet soft drinks experienced a 70% greater increase in waist circumference than nonconsumers. Further, among elderly drinkers of 2 or more diet soft drinks per day, mean increases in waist circumference were 5 times greater than those recorded for nonconsumers.
“These results suggest that — amidst the national drive to reduce consumption of sugar-sweetened drinks — policies that promote the consumption of diet soft drinks may have unintended deleterious effects,” state the study investigators.
Previous work by Ms. Fowler has evaluated the negative effects of diet drinks (Obesity [Silver Spring]. 2008;16:1894-1900).
Ms. Fowler has disclosed no relevant financial relationships.
American Diabetes Association (ADA) 71st Scientific Sessions: Abstract 0062-OR. Presented June 25, 2011.
Reduced Risk of Diabetes with Higher Vitamin D Levels
June 25, 2011 (San Diego, California) — Higher levels of vitamin D in the blood appear to be associated with a reduced risk for incident diabetes among people at high risk for the disease, according to a new report.
Anastassios G. Pittas, MD, from the division of endocrinology, diabetes, and metabolism at the Tufts New England Medical Center in Boston, Massachusetts, and colleagues presented the findings here at the American Diabetes Association 71st Scientific Sessions.
According to Dr. Pittas, vitamin D might play a role in diabetes by improving insulin secretion and insulin sensitivity. “Most of the evidence focuses on a favorable effect in pancreatic beta cells,” he told Medscape Medical News.
To determine the relation between vitamin D status and risk for incident diabetes, the researchers analyzed data from the Diabetes Prevention Program (DPP), a 3-group trial comparing intensive lifestyle modification or metformin with placebo for the prevention of diabetes in patients with prediabetes.
The mean follow-up of the 2039-person cohort was 3.2 years. Plasma vitamin D levels were measured at yearly intervals, and subjects were assessed for incident diabetes. For this analysis, only participants in the intensive lifestyle and placebo groups of the DPP were considered.
Participants with vitamin D levels in the highest tertile (median concentration, 30.1 ng/mL) had a hazard ratio of 0.74 (95% confidence interval [CI], 0.59 to 0.93) for developing diabetes, compared with those with vitamin D levels in the lowest tertile (median concentration, 12.8 ng/mL).
The findings also suggest a dose-dependent effect for vitamin D levels; the hazard ratio for incident diabetes was lowest (0.46; 95% CI, 0.23 to 0.90) in the people with the highest vitamin D levels (50 ng/mL or higher), compared with those with the lowest levels (below 12 ng/mL).
In a subgroup analysis by tertiles of vitamin D, the association was similar in the placebo group (0.72; 95% CI, 0.53 to 0.96) and the lifestyle group (0.80; 95% CI, 0.54 to 1.14).
According to Dr. Pittas, “this study offers several methodological advantages over previous studies.” Vitamin D status was assessed multiple times during follow-up, not just once at baseline, which might not reflect long-term vitamin D status.
“Our study also includes a large clinically relevant population at high risk for diabetes, with a substantial proportion of nonwhite participants, which improves the external validity of the results,” he said. However, he added, “this is an observational study and therefore confounding cannot be excluded. It would be premature to recommend vitamin D specifically for prevention of diabetes.”
“This prospective study confirms that there is an association between levels of vitamin D and risk of diabetes, even when correcting for body weight, with no absolute threshold of serum 25-hydroxy vitamin D,” said independent commentator Clifford Rosen, MD, from the Jackson Laboratory in Bar Harbor, Maine. Dr. Rosen is a vitamin D researcher and member of the Institute of Medicine Committee that reviewed the evidence on calcium and vitamin D.
“The implications of this study relate to the importance of performing a randomized placebo-controlled trial of vitamin D for the prevention of type 2 diabetes in those at high risk,” he told Medscape Medical News. “In the interim, clinicians should at least focus on maintaining vitamin D levels in high-risk individuals at or around 20 ng/mL,” he added.
The study was not commercially funded. Dr. Pittas and Dr. Rosen have disclosed no relevant financial relationships.
American Diabetes Association (ADA) 71st Scientific Sessions: Abstract 0117-OR. Presented June 25, 2011.
Type II Diabetes Reversal
TYPE 2 DIABETES REVERSED WITH EXTREME DIET
A small but landmark study has found that type 2 diabetes patients who followed for two months, an extreme but tightly supervised diet that restricted calories to just 600 a day experienced a return to normal pre-breakfast blood sugar levels after one week and that 70 percent of those patients remained completely free of diabetes a month after returning to their regular, but newly portion-controlled, diet.
Type 2 diabetes is a condition in which blood sugar levels are too high due to insufficient insulin or the inability to use insulin effectively. The researchers believe excess calories eventually cause fat buildup in the liver and pancreas, triggering type 2 diabetes. MRI scans of study subjects showed the pancreas returns quickly to normal fat levels and regains its ability to produce insulin.
This suggests type 2 diabetes may be reversed by calorie restriction alone.
A 600-calorie diet is a drastic, starvation diet that should only be followed temporarily and only under close practitioner supervision.
Presented June 24, 2011 at the American Diabetes Association conference, this study will appear in a future issue of the journal Diabetologia, but is now accessible online at http://bit.ly/mDicGp without cost.
The Polyphenol for Baby Boomers
HUMAN BENEFIT FROM RESVERATROL FURTHER SUGGESTED
Following their research review of the limited number of studies conducted so far that have direct relevance to humans, researchers have suggested that, although the polyphenol compound known as resveratrol may not prevent or retard actual aging, it may indeed help prevent some of the chronic conditions associated with old age, although more long-term human studies are urgently needed.
Despite an abundance of evidence pointing to the beneficial effects of resveratrol, a compound found in grapes and wine, very few studies have been done on humans and the bioavailability of resveratrol in humans, as opposed to animals, is still in doubt.
Gathering together evidence from previous studies on animals, cultures and enzymes, the team found indication that resveratrol may have anti-oxidant, anti-cancer, and anti-inflammatory effects.
Scientists suggest that if the ability of resveratrol to alleviate age-related infirmities is established in humans, it could have vast importance as the baby boomer generation enters old age.
This just-released study will appear in a future issue of the journal Molecular Nutrition & Food Research. The full-text study is available online now at http://bit.ly/kG4aWy with subscription or fee.
High Dose Statin Therapy Increases Risk of Diabetes
High-Dose Statin Therapy Increases the Risk of Diabetes
June 21, 2011 (London, United Kingdom) — A meta-analysis of some of the more high-profile statin trials testing the effectiveness of high-dose therapy has revealed a significant increase in the risk of diabetes mellitus associated with statin use in high doses [1]. Compared with moderate-dose therapy across five statin trials, investigators report that treatment with high-dose statins increased the risk of diabetes by 12%.
Senior investigator Dr Kausik Ray (St George’s University of London, UK) said that while there might be consequences from the raised blood glucose levels, researchers do not yet know what these long-term effects mean. The net benefit of high-dose statin therapy “is definitely in favor” of using the drugs, he said.
“One thing we do know is that there does appear to be a dose effect with statin therapy, with the risk of diabetes mellitus increasing with higher doses,” Ray told heartwire . “Statins have multiple effects and cause a number of changes. What we’re seeing is probably an off-target effect, and right now we have no obvious mechanisms. However, lowering LDL-cholesterol levels is probably more important than the increase in blood-sugar levels.”
In their analysis, the number of patients needed to treat with high-dose statin therapy to prevent one cardiovascular event was 155, whereas the number needed to treat to cause one case of new-onset diabetes mellitus was 498. Overall, high-dose statin therapy reduced the risk of cardiovascular events in their meta-analysis by 16% compared with low- or moderate-dose statin therapy.
The results of the study are published in the June 22, 2011 issue of the Journal of the American Medical Association.
Previous Observed Diabetes Risk
Ray said that the idea for the meta-analysis began two years ago, when the signal for diabetes risk was observed in Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER). The group later performed an analysis of some of the early statin trials comparing the lipid-lowering drugs with placebo in 90 000 individuals and observed a significant 9% increase in the risk of diabetes mellitus. That study was reported in the Lancet in 2010 [2].
In this newest analysis, the researchers included large, randomized, controlled, hard-end-point studies that compared intensive–dose statin therapy with moderate-dose statin therapy followed for more than one year. The trials included in the meta-analysis were PROVE-IT, A to Z, TNT, IDEAL, and SEARCH, five trials that together included 32 752 patients without diabetes mellitus at baseline.
“We wanted to look at the different studies comparing the intensity of statin treatment,” said Ray. “If the diabetes finding was a real finding, we would expect to see it in the statin trials that tested different intensities of treatment in about 33 000 subjects. The trials all ranged from two to five years in duration, and we had information from five trials comparing high versus low/moderate treatment doses. Our results support our initial findings. We observed a 12% increase in risk for those patients treated with high-dose statin therapy.”
In total, 1449 patients treated with high-dose statin therapy developed diabetes compared with 1300 patients assigned to moderate-dose statin therapy. This translated into two additional cases of diabetes mellitus per 1000 patient-years. The odds ratio for new-onset diabetes was 1.12 (95% CI 1.04–1.22). Regarding benefit, 3134 patients treated with high-dose statin therapy and 3550 patients treated with moderate-dose therapy had a cardiovascular event, translating into 6.5 fewer outcomes per 1000 patient-years in the high-dose statin arm, or a relative reduction of 16%.
The investigators did observe differential effects with the different drugs. Whereas atorvastatin 80 mg and simvastatin 80 mg were both associated with similar risks of diabetes mellitus, the benefit differed significantly, with evidence in favor of atorvastatin (22% vs 5% risk reduction for cardiovascular events). The data, said Ray, support the recent Food and Drug Administration (FDA) decision to warn physicians to not start new patients on simvastatin 80 mg and to be vigilant to the risks of muscle toxicity caused by the drug in those who are still taking it.
Getting Patients to Goal
Dr Brendan Everett (Brigham and Women’s Hospital, Boston, MA), who was not involved in the analysis, agreed with the conclusions of Ray and colleagues, that the signal observed in this latest analysis supports the findings from JUPITER and the Lancet meta-analysis “and supports the idea of a dose effect, that there is an increasing risk of diabetes with increasing doses of statins.”
Everett said the investigators helped clinicians by providing data on the relative benefits and relative harms of high-dose statin therapy. The number needed to treat to prevent one cardiovascular event and number needed to treat to cause one new case of diabetes mellitus clearly support the use of high-dose statin therapy in the patients studied in the five clinical trials.
“The benefits of statins for reducing important macrovascular events is so overwhelming that the balance is clearly on the side of benefit,” said Everett. “This is an important point that shouldn’t be forgotten.”
Dr Roger Blumenthal (Johns Hopkins University Medical Center, Baltimore, MD) agreed, stating that while “it makes sense that higher doses [of statins] would have slightly higher adverse effects,” there is still no proposed mechanism for the increased risk of diabetes. Like the others, the benefits of moderate/high doses of statins outweigh the risks, although he added that some physicians might decide to downgrade the dose based on these new data.
In addition, Dr Steven Nissen (Cleveland Clinic, OH) said that the effect is likely real as it has been observed in enough trials and analyses. That said, “it is notable that despite the increase in the risk of diabetes mellitus, the reduction in cardiovascular morbidity and mortality is maintained,” he added. “It leads me to believe that the effect is not very clinically significant.”
Everett added that what is currently unknown is how the risks of diabetes mellitus differ in other patient populations. Clinicians need to understand their patients’ baseline risks of cardiovascular disease and diabetes mellitus when making a decision about high-dose statin therapy, and it will be important to determine whether patients at greater risk for adverse side effects can be identified. Researchers will also need to determine what effects high-dose statin therapy has on microvascular complications, such as retinopathy.
“The bottom line is that we need to follow up on the signal, but I don’t believe the results should change treatment goals,” said Everett. A failure to aggressively treat patients at high risk for cardiovascular events will result in an excess of clinical events, he added.
Ray suggested that clinicians monitor HbA1c levels when treating patients with high-dose statin therapy.
Like Ray, Everett said the results support the FDA decision regarding simvastatin 80 mg, that the drug is associated with more side effects without a corresponding balance of efficacy. In the interest of getting patients to treatment goal and trying to do so in a cost-efficient manner, some physicians had been using high-dose simvastatin. However, if they are unable to get to goal at 40-mg simvastatin, switching over to other, nongeneric drugs is not difficult, although it does involve extra paperwork when dealing with drug payers, he said.
This Sunday at the American Diabetes Association (ADA) 2011 Scientific Sessions, Dr David Preiss (University of Glasgow, Scotland), the first author of the analysis, will present their data at a special symposium organized by the ADA and FDA. The presentation will highlight the newly observed risks with high-dose statin therapy, as well as their Lancet analysis of 13 randomized trials comparing placebo and standard-therapy trials.
References
- Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy. JAMA 2011; 305:2556-2564.
- Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statins trials. Lancet 2010; 375:735-742. Abstract
Smokers & Prostate Cancer
SMOKERS HAVE HIGHER RISK OF PROSTATE CANCER RECURRENCE AND DEATH
A study has found that smokers who develop prostate cancer have a 61% greater risk of a recurrence after treatment, and a 61% higher risk of dying from prostate cancer, compared to nonsmokers diagnosed with prostate cancer.
Researchers also found that smokers who are initially diagnosed with non-metastatic prostate cancer have an 80 percent greater risk of dying from this disease than nonsmokers.
A link was also found between smoking and more aggressive forms of prostate cancer.
Smokers who were diagnosed with prostate cancer also showed a 131% higher risk of dying from cardiovascular disease. However, men who had quit smoking for ten years or more prior to being diagnosed with prostate cancer had the same level of risk as nonsmokers.
Prostate cancer is the most frequently diagnosed form of cancer in the US.
The team stressed that quitting smoking directly reduces the risk of dying from prostate cancer. This study will be published in the June 22-29, 2011 issue of the Journal of the American Medical Association. It is accessible online now at http://bit.ly/lnj1Ur with subscription or fee.
60% of Arthritis Cases Affect…?
feet.
Did you know?…
High heels are partly to blame for an arthritis problem that has become epidemic in the UK.
A June 2011 study by the Society of Chiropodists and Podiatrists reports that in the UK, one in four adults (25% of the adult population) has a muskuloskeletal condition, and 60 percent of arthritis cases are in the feet!
Given the popularity and resurgence of high heels in the US, we probably aren’t far behind.
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Just Say No to Vending Machine Foods
SNACK-BASED, HIGH-FAT DIET RISKIER THAN SIMPLE HIGH-FAT DIET
A study has found that – compared to rats in most studies that are fed high-fat diets through the introduction of foods made from lard – rats fed a high-fat diet comprised of snack foods humans actually eat experienced higher consumption, greater weight gain, more tissue inflammation, and intolerance to glucose and insulin.
Researchers suggest that while rodent studies have often pointed to serious health risks resulting from a high-fat diet, even more severe health risks result from a high-fat diet in which the dietary fat comes from the so-called cafeteria diet, a lab research term describing the common Western diet of buffet-style access to junk food such as processed meats, cookies, and chips. The team found that rats fed the real-life cafeteria diet consumed about 30 percent more calories than those on a high-sugar, or regular high-fat diet, and were more prone to metabolic syndrome (a cluster of factors that increase the risk of coronary artery disease, stroke, and diabetes type 2).
Published June 17, 2011 in the online issue of Obesity, this study is accessible at http://bit.ly/lFVppQ free of charge.
Shellfish Linked to Lower Risk of Diabetes
SHELLFISH LINKED TO LOWER RISK OF DIABETES
Researchers have found an association, for women only, between higher consumption of fish and reduced risk of diabetes type 2, as well as an association for both men and women, between higher consumption of shellfish and reduced risk of diabetes.
Previously, some experts had suggested that long-chain, polyunsaturated, omega-3 fatty acids, which are found mainly in fish, may be a factor in helping to prevent diabetes type 2, but this theory remains unresolved. This study reviewed the diets of 116,156 people and found that women in the highest fifth of fish consumption had an 11 percent reduced risk of diabetes, while men in the highest fifth of fish consumption showed a lower risk that was not statistically significant.
They also found that women in the highest fifth of shellfish consumption had a 14 percent reduced risk of diabetes, while men in the highest fifth of shellfish had an 18 percent lower risk. The team did not find a health risk linked to greater fish consumption. This just-released study will appear in a future issue of the American Journal of Clinical Nutrition. It is available online now at http://bit.ly/kla0Uw with subscription or access fee.