HEALTH TIPS FOR THE HOLIDAY SEASON

holidays

Mashed potatoes and gravy, Grandma’s apple pie, and other holiday favorites can be a joyous part of any celebration. But to feel your best, you know you need to eat in moderation and stay active. How can you avoid temptation when delicious foods and calories abound?

From Halloween through New Year’s, there’s always a decision to make about food. . Tasty treats tend to appear more often at work and festive gatherings, and to come as gifts. They may also tempt you when grocery shopping. Thus as the holidays approach, it’s important to think ahead and make a plan.

Consider your health goals for the holiday season, whether it’s preventing weight gain through overeating, staying active, connecting with others, or reducing stress. You can plan to make time for buying healthy groceries, cooking at home, scheduling regular physical activity, and setting aside a little quiet time for yourself.

Begin by adopting a flexible mindset. Many people have an attitude of all or nothing: either I’m on a diet or I’m not on a diet.  This “either-or” thinking can lead to negative self-talk, or being hard on yourself for small indulgences, overeating, or weight gain.

Unfortunately most people just throw their plan out the window when they think they’ve slipped up once. Celebrations don’t have to derail your lifestyle. You’ll have plenty of opportunities to follow your plan and eat healthy and feel good about it. Small choices really can make big changes. Each moment that you put something in your mouth or choose to exercise adds up over time, which can be true for weight loss or weight gain.Around the holidays, we often find ourselves with too many food options, for too many days in a row. It can be challenging to decide what to eat and when to say no.

Eat what you love—but in moderation. Consider choosing items that are unique to the season, instead of eating foods you can have any time of the year. When you feel the urge to splurge in unhealthy ways, try something else first, like drinking a glass of water, eating a piece of fruit, or climbing a few flights of stairs. You might even consider walking around your house or office for 5 minutes or more. Such diversions might be enough to help you resist unhealthy temptations. You could also try eating more deliberately. Slow down to really taste and enjoy your food. Eating more slowly also allows your body time to signal your brain when you’re full, which takes about 20 minutes. If you eat too much too quickly, it’s easy to gobble up as much as twice what your body needs before your brain even gets the message. Also it’s a good idea to identify and avoid any “trigger foods”—foods that may spur you to binge or eat more than usual. Overeating can bring feelings of bloating, reflux, indigestion, and nausea. Some people can eat less healthy foods in moderation and be fine, or have “cheat days” where they allow themselves to eat whatever they want for a day and stay on track for the rest of the week.. Others may have to avoid certain “trigger foods” completely, or they’ll spiral into unhealthy eating patterns for the rest of the week or abandon their plan altogether. Everyone is different. Because of these differences, it’s important not to force food on other people. Even if you don’t have an issue with food, be aware of other people around you, and respect their choices.

What if you do fall to temptation?  Happily every day is a new day when it comes to eating. If you overeat one day, work to get back on track the next meal or next day.

While food is a big part of the holidays, remember that there are other paths to staying healthy. Don’t make the holidays be just about food. The key is not only what you eat, but how much you’re moving. Even little bits of extra exercise can be very helpful for everyone over the holidays.

Plan ahead for how you’ll add physical activity to days that might otherwise involve a lot of sitting. When possible, get the whole family involved. You have to make an effort to incorporate exercise into days of big eating. Otherwise the day will come and go.Sign up to walk or run a community race. Enjoy catching up with family or friends on a walk or jog instead of on the couch. In between meals, take a family hike at a nearby park or stroll around your neighborhood..

The emotions of winter celebrations come into this picture, too. Joy, sadness, and stress are often associated with overeating during the holidays. People who are emotional eaters may be particularly vulnerable to such temptations around the holidays. If holiday stress causes you to derail your healthy plans, consider ways to reduce stress and manage emotions. These might include talking to a trusted friend, meditation, physical activity, or just getting outside. If you know you have a difficult time during holidays, plan outings once or twice a week with people who make you feel happy. If it’s in your best interest, also feel okay about declining invitations without feeling guilty.

Support your family and friends, too. Encourage them to eat healthy during celebrations and throughout the year. If you’re serving dinner, consider baking, broiling, or grilling food instead of frying. Replace sour cream with Greek yogurt, and mashed potatoes with mashed cauliflower. Make take-home containers available ahead of time, so guests don’t feel they have to eat everything in one sitting.

So you needn’t adopt a defeatist attitude around the holiday season. Be proactive, and fight the flab at the same time.

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DOES IT EVER PAY TO BE FAT?

overweight-scale


During the past several years, a misconception—the so called “obesity paradox”—has been creeping into the medical literature. This paradox is a medical hypothesis which holds that obesity (and even high cholesterol), counter intuitively, may be protective and associated with greater survival in certain groups of people, such as very elderly individuals or those with certain chronic diseases. It further postulates that normal to low body mass index or normal values of cholesterol may be detrimental and associated with higher mortality in asymptomatic people.

But is there any truth to this hypothesis? As we note below, the answer to this question is, no!

    A large international study that included Harvard researchers links a high body mass index (BMI)-a calculation used to determine if a person is overweight-to a risk of early death, and contradicts the idea that it’s possible to be fat and fit. Researchers pooled the data from 239 studies of more than 10 million people in 32 countries. They excluded people who had smoked, had a chronic condition, or died within five years of follow-up, leaving about four million people. Of those, researchers analyzed people’s BMIs (Body Mass Indices). A healthy BMI (non-obese) is considered to be in the range from 18.5 to 24.9. Researchers observed that study participants with a BMI of 20 to 24.9 were the least likely to die during the study period; people with a BMI above that were significantly more likely to die during the study period, especially men with high BMIs. The findings, published Aug. 20, 2016, in The Lancet, don’t prove that high BMIs cause early death, but they do suggest being overweight matters.

The bottom line: Extra fat puts you at risk for developing diabetes, heart disease, and cancer, so make weight control a priority, and avoid making phony excuses for being fat!

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NEW CAUTION WHEN CONSIDERING ANTACID MEDICATION

prilosec

A popular group of antacids known as proton pump inhibitors, or PPIs, used to reduce stomach acid and treat heartburn may increase the risk of  the most common form of stroke (“ischemic stroke”), according to preliminary research presented at the American Heart Association’s Scientific Sessions 2016.

“PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia,” said Thomas Sehested, MD, study lead author and a researcher at the Danish Heart Foundation in Copenhagen, Denmark. “We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population.”

Researchers analyzed the records of 244,679 Danish patients, average age 57. During nearly six years of follow up, they assessed stroke rates while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium)., all being obtainable over the counter in the U.S.A.

For ischemic stroke, researchers found:

  • Overall stroke risk increased by 21 percent when patients were taking a PPI.
  • At the lowest doses of the PPIs, there was slight or no increased stroke risk.
  • At the highest dose for these 4 PPI’s, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix).
  • There was no increased risk of stroke associated with another group of acid–reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).

The study corrected for age, gender and medical factors, including high blood pressure, atrial fibrillation (irregular heart beat), heart failure and the use of certain pain relievers that have been linked to heart attack and stroke. The authors suggested that their findings, along with previous studies, should encourage more cautious use of PPIs. .
“At one time, PPIs were thought to be safe, without major side effects,” he said, “This study further questions the cardiovascular safety of these drugs.”

Since it was an observational design, this study could not definitively establish cause and effect between PPIs and strokes. For this reason, the authors believe that a randomized controlled trial of PPIs and cardiovascular disease is warranted.

In the meantime, how should each of us respond to this information? First, we should carefully consider whether use of PPIs is warranted at all, and for how long:

Given the relative safety of the H2 blockers such as Zantac and Pepcid, they should be tried first after ordinary antacids such as Mylanta, Di-Gel, Gelusil, etc. are tried and found wanting. Only then should we consider the PPIs, and used for as brief a period as possible.

 

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UNIFYING THE NATION: A SUGGESTION

   As a physician, I have always been concerned with health—usually of the individual’s body and/or mind. Presented with a recent and blatant disregard for fairness in politics, I am very concerned about the health of our nation as a whole. What I write below should be of concern to all.

If you agree with me, please share this message with as many contacts as possible. Maybe we can make a difference!

                 OPEN LETTER TO DONALD TRUMP

After a divisive campaign that has threatened to leave sharp divisions in this country, you have now professed, in conjunction with your recent rhetoric, that you wished to unify this nation and provide a leadership for all Americans — no matter what race, religion, gender, or political party.

If this is your true wish, I have an important suggestion for you that will set you on this path and involve little risk to you or your party. Simply express your support for the appointment of Merrick Garland to the Supreme Court of the U.S.A.

Let’s look at the reasons for my suggestion: After graduating from Harvard College and Law School with high honors, he practiced corporate litigation and worked as a federal prosecutor in the U.S. Department of Justice, where he played a leading role in the investigation and prosecution of the Oklahoma City bombers. He later returned to public service in 1989, becoming an Assistant U.S. Attorney in the U.S. Attorney’s Office for the District of Columbia. As a prosecutor, Garland represented the government in criminal cases ranging from drug trafficking to complex public corruption matters.

In 1995, after being nominated to the vacated D.C. Circuit Court, the American Bar Association (ABA) Standing Committee on the Federal Judiciary gave Garland a “unanimously well-qualified” committee rating—its highest.   On January 7, 1997, Garland was renominated  for the Circuit Court, and he was confirmed in a 76–23 vote. The majority of Republican senators voted to confirm Garland, including Senators John McCain, Orrin Hatch, Susan Collins, and Jim Inhofe.

After the April 2010 announcement by Justice John Paul Stevens that he would retire, Garland was again widely seen as a leading contender for a nomination to the Supreme Court of the United States. President Obama interviewed Garland, among others, for the vacancy. In May 2010, Senator Orrin G. Hatch, Republican of Utah, said he would help Obama if Garland were nominated, calling Garland “a consensus nominee” and predicting that Garland would win Senate confirmation with bipartisan support. Obama instead nominated Solicitor General of the United States Elena Kagan, who was confirmed in August 2010.

On March 11, 2016, Senator Orrin Hatch, president pro tempore of the United States Senate and the most-senior Republican Senator, predicted that, although President Obama would name someone the “liberal Democratic base” wanted, he “could easily name Merrick Garland, who is a fine man”. Five days later, on March 16, Obama formally nominated Garland for Supreme Court Justice. Garland is considered a judicial moderate and a centrist. Tom Goldstein, the publisher of SCOTUSblog, wrote in 2010 that “Judge Garland’s record demonstrates that he is essentially the model, neutral judge. He is acknowledged by all to be brilliant”.

On March 16, 2016, President Obama nominated Garland to serve as an Associate Justice of the Supreme Court, to fill the vacancy created by the death of Antonin Scalia. To date, the Senate has not held a hearing or vote on the nomination, since the Senate Republicans have refused to consider it. Inasmuch he has already been vetted and believed to be highly qualified by both parties, his rejection has been clearly intended as a Republican repudiation of President Obama.

So now, Mr. Trump, the ball is in your court. Here is your chance to start the unification process by supporting the appointment of a truly gifted and centrally oriented justice, already recognized as an outstanding choice by both parties and providing a unifying force for all Americans! Put in your own parlance, what do you have to lose?

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DIETING: DON’T FORGET HUNGER

hunger

Throughout the evolution of all species, including humans, food intake has been governed primarily by the sensation of hunger. This may explain why obesity is seldom encountered in animals. Although records are obviously limited prior to the dawn of civilization, human obesity is likely also to have been rare. Thus it is likely that, when guided by the primordial sense of hunger, all bodies will likely respond with the attainment of a normal food intake and weight. Also, when combined with a large requirement of physical work through antiquity, humans were destined to keep food intake and caloric consumption in a delicate and proper balance.

For at least the past century, our dietary intake has been largely decoupled from hunger for a variety of reasons. We often adhere to regular “eating hours” such as noon for lunch, meals are often centered on social functions rather than hunger, snack foods are easily available when sitting to watch TV, with the addition of a “yummy” dessert, we often exceed eating requirements beyond the point of satiation, and the list goes on and on. Compounding this problem further, requirements for physical effort have been greatly reduced for obvious reasons.

So what am I trying to say? If our food intake were governed solely by hunger and limited by satiation, a large component of weight control would be in place, and any diet strategy would be more apt to succeed if this principle were observed.

This hypothesis has been recently tested by experimental data appearing in a 2016 study in the American Society for Nutrition entitled “Intuitive Eating Dimensions Were Differently Associated with Food Intake in the General Population.” The study compared the so-called “intuitive eating, i.e., eating in response to physiological hunger and satiety cues rather than emotional cues, termed “unconditional permission to eat”. Prior evidence had supported the idea that such intuitive eating was associated with lower body weights, but little was known about its association with food intake per se.

The study noted above included a total of 9581 men and 31,955 women aged ≥18 years. Eating patterns were assessed by using a validated version of a detailed intuitive eating scale derived from dietary records over a six year period. The associations were compared between intuitive eating and unconditional permission to eat, and food intakes were assessed by statistical analysis.

Results from this study were quite illuminating: In women, higher physical reasons scores were associated with lower caloric intakes. Also, a higher physical reasons score was associated with lower sweet- and fatty-food intake in both women and men, as well as lower intakes of dairy products, meat, fish, and eggs, and a higher whole-grain intake in women. In contrast, higher intuitive eating scores were generally associated with a higher caloric intake that contained lower fruit, vegetable, and whole-grain intakes.

The conclusion of the study: Physical hunger is associated with healthier dietary patterns with better weight control, whereas the so-called “unconditional permission to eat”, was associated with unhealthier diets. From a public health perspective, these findings suggest that we all should be eating primarily in response to hunger and satiety signals rather than the myriad of emotional/social signals. What remains to be proved, however, is, whether those individuals already controlled by emotional factors can be converted to a dominant pattern of food consumption in response to hunger

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EATING TIMES AND OBESITY

obese

The first human test of early time-restricted feeding is showing that this meal-timing strategy may help reduce swings in hunger and altered fat- and carbohydrate-burning patterns.

In early time-restricted feeding (eTRF), individuals eat their last meal by the mid-afternoon and do not eat again until breakfast the next morning. In a recent new study, researchers found that eating only during a much smaller window of time than people are typically used to may help with weight loss.

Researchers at the University of Alabama found that eating between 8 am and 2 pm followed by an 18-hour daily fast kept appetite levels more even throughout the day compared with eating between 8 am and 8 pm. The findings suggest that eating a very early dinner, or even skipping dinner, may have some benefits for losing weight. The body has an internal clock, and many aspects of metabolism are at their optimal functioning in the morning. It is theorized that eating in alignment with the body’s circadian clock by eating earlier in the day may positively influence health.

The current study of eTRF suggests this eating pattern may affect metabolism. This first test of eTRF in humans follows rodent studies of this approach to weight loss, which previously found that eTRF reduced fat mass and decreased the risk of chronic diseases in rodents.

The researchers conducted a study with 11 men and women between aged 20 to 45 years (mean age: 32 years). All participants were followed over 4 days of eating between 8 am and 2pm (eTRF), and 4 days of eating between 8 am and 8 pm (average feeding for Americans). The researchers then tested the impact of eTRF on calories burned, fat burned, and appetite.

To eliminate subjectivity, the researchers had all participants try both eating schedules, consuming the same number of calories both times, and completing rigorous testing under supervision. They found that although eTRF did not affect how many calories participants burned, it reduced daily hunger swings and increased fat burning during several hours at night. It also improved metabolic flexibility.

This type of information opens up an intriguing possibility for those wishing to lose weight—nearly the entire population. Early dining during the afternoon hours not only reduces eating to twice daily but also allows for the avoidance of later crowds in restaurants. But, to be successful, this approach must not include a bedtime snack, difficult for many people!

 

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Golf’s many benefits brought to the fore in health study

 

 

golf

You might be surprised that golf has physical and mental health benefits for people of all ages, genders and backgrounds, according to a study in the British Journal of Sports Medicine. Researchers reviewed 5000 studies into golf and well-being to build a comprehensive picture of the sport’s health benefits, as well as its potential drawbacks. Findings show that golf is likely to improve cardiovascular, respiratory and metabolic health. Playing golf could also help those who suffer chronic diseases including heart disease, type 2 diabetes, colon and breast cancer and stroke, the study found. The physical benefits of golf increase with age, researchers from the University of Edinburgh said. Balance and muscle endurance in older people are improved by playing the sport, the review also found. The study found that golfers typically burn a minimum of 500 calories over 18 holes. Golfers walking 18 holes can cover four to eight miles, while those using an electric golf cart typically chalk up four miles. Increased exposure to sunshine and fresh air were found to be additional benefits. The physical aspects of golf could also help reduce the risk of anxiety, depression and dementia, the researchers say.

Anyone who has played golf can attest to its physical benefits. However, these physical advantages could easily be overshadowed by its mental challenges; I’ve seen many a mature adult reduced to a “gibbering idiot” after missing a multitude of shots! Nevertheless, the net effects seem to be positive, provided your golf game doesn’t require confinement in a mental institution!

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TURMERIC: ANOTHER OF THE MANY SNAKE OILS?

curry

     I recently encountered a website touting the “tremendous’ health benefits of Turmeric. Having been intrigued, I decided to look into the background of its claims.

Turmeric (Cucurma longa) is a plant in the ginger family that is native to southeast India. It is also known as curcumin. The rhizomes are ground into an orange-yellow powder that is used as a spice in Indian cuisine. You probably know turmeric as the main spice in curry. It has traditionally been used in folk medicine for various indications; and it has now become popular in alternative medicine circles, where it is claimed to be effective in treating a broad spectrum of diseases including cancer, Alzheimer’s disease, arthritis, and diabetes. One website claims science has proven it to be as effective as 14 drugs, including statins like Lipitor, corticosteroids, antidepressants like Prozac, anti-inflammatories like aspirin and ibuprofen, the chemotherapy drug oxaliplatin, and the diabetes drug metformin.. Whenever one encounters such excessive claims that sound “too good to be true”, that’s exactly what they usually  prove to be.

The Natural Medicines Comprehensive Database has reviewed all the available scientific studies and has concluded that turmeric is “Likely Safe,” “Possibly Effective” for dyspepsia and osteoarthritis, with “Insufficient Reliable Evidence” to rate effectiveness for other indications, such as Alzheimer’s disease, colorectal cancer, rheumatoid arthritis, and skin cancer.

Mechanism of action

The pertinent preclinical studies, in animal models and in vitro, indicate that curcumin, the presumed active ingredient in turmeric, has anti-inflammatory properties; can induce apoptosis (death) in cancer cells and may reduce microscopic changes of Alzheimer’s brains; has antithrombotic effects; and displays activity against some bacteria,. These effects sound promising, but animal studies and in vitro laboratory studies may not be applicable to humans. Although you can kill cancer cells in the laboratory with a flame thrower or bleach, animal studies must always be followed by clinical studies in humans before we can make any recommendations to humans.

Preliminary clinical research

Preliminary pilot studies of turmeric in humans suggest the following:

  • it does not change mental state examination scores in Alzheimer’s
  • it might improve symptoms in anterior uveitis (eye inflammations)
  • it might stabilize some markers of colorectal cancer in some patients with treatment refractory colorectal cancer
  • high doses may decrease the number of aberrant focal abnormalities detected on colonoscopy
  • it might reduce some symptoms of rheumatoid arthritis.

Clinical research on turmeric is currently funded by the National Center for Complementary and Alternative Medicine (NCCAM), but the NCCAM website is not very encouraging. Under the section What the Science Says, it states:

  • There is little reliable evidence to support the use of turmeric for any health condition because few clinical trials have been conducted.
  • Preliminary findings from animal and other laboratory studies suggest that a chemical found in turmeric—called curcumin—may have anti-inflammatory, anticancer, and antioxidant properties, but these findings have not been confirmed in people.
  • NCCAM-funded investigators have studied the active chemicals in turmeric and their effects—particularly anti-inflammatory effects—in human cells to better understand how turmeric might be used for health purposes. NCCAM is also funding basic research studies on the potential role of turmeric in other diseases..

I might add parenthetically that NCCAM has, in its entire history, produced virtually nothing that might alter our current practice of science-based medicine.

Side effects

Turmeric is generally considered safe, but high doses have caused indigestion, nausea, vomiting, acid reflux, diarrhea, liver problems, and worsening of gallbladder disease. It may interact with anticoagulants and antiplatelet drugs to increase the risk of bleeding, that it should be used with caution in patients with gallstones or gallbladder disease and in patients with gastroesophageal reflux disease, and it should be discontinued at least 2 weeks before elective surgery. Purchasers of supplements are not given that information.

Conclusion

The scientific evidence for turmeric is insufficient for managing any human health problems. As with so many supplements, the hype has far exceeded the evidence, and this serves only to separate the public from its money. Although there are some promising hints that this substance may be useful, there are plenty of promising hints that lots of other supplements “may” be useful too. Given this monumental lack of substantive evidence, I see no reason to jump on the turmeric bandwagon. Stay tuned for further evidence, however, in the form of well-designed clinical studies in humans. Once in a very long while, we accidentally encounter a really effective drug such as quinine or aspirin, but usually we wind up instead in the “snake oil pit.”

 

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TRUMP SUPPORTED ANTI-VACCINATION GROUP

     vaccines

The Daily Beast (Sept 30, 2016) has reported that in 2010 the Donald J. Trump Foundation donated $10,000 to former Playboy model Jenny McCarthy’s anti-vaxx crusade, also contributing to Generation Rescue, a group that promotes dubious treatments, refers to questionable practitioners, opposes standard vaccination recommendations, and insists that vaccines are a major cause of autism. Donald Trump himself has also claimed that vaccines have caused many cases of autism, an assertion totally refuted by all scientists, again reflecting Trump’s world-class ignorance! The Trump Foundation’s 2010 tax return identifies Donald Trump as the foundation’s president and his children, Donald Jr., Eric, and Ivanka, as its directors.

Of special interest during this election season is the strong likelihood that the money donated by this foundation did not come from Trump’s own pockets (which are likely far less deep than he originally boasted). Moreover, did the unwitting donors to Trump’s “foundation” think that their money was going to worthy causes—obviously unsupported by the evidence. Also, did those same donors take a tax deduction for the money sent to this questionable “foundation?” They, too, may be unpleasantly surprised if they, presumably like Trump (?), undergo a tax audit.

As the old statement goes—largely attributed to P.T. Barnum—there’s a sucker born every minute!  But must it be at the expense of our kids’ health, or even lives?

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CLIMATE CHANGE AND HUMAN HEALTH: LITTLE KNOWN FACTORS

climate-change

At this time, most thoughtful people acknowledge the reality of humanly generated climate change on our environment, but they often fail to understand the real threat this poses to human health in general.

Now, the American College of Physicians (ACP), one of our most respected medical institutions, has issued a sobering position paper on climate change and it effects on human health§, including higher rates of respiratory and heat-related illness, increased prevalence of vector-borne and waterborne diseases, food and water insecurity, and malnutrition. Persons who are elderly, sick, or poor are especially vulnerable to these potential consequences, according to this group. The ACP also states its belief that it’s incumbent on all those in the health industry to play an active role in protecting human health and averting dire environmental outcomes.

This ACP publication emphasizes that climate change presents a “catastrophic risk” to human health over the next hundred years that may wipe out all of the health advances made over the previous 100 years. The average temperature on Earth has increased by almost 1 degree since 1889, and greenhouse gas emissions have increased by almost 50% from 2005 to 2011. It is predicted that by the end of the century, the Earth’s temperature may increase by 5 to 9 degrees Fahrenheit. Ice in the Arctic and Antarctic seas has melted at unprecedented rates and the water levels worldwide have risen by almost 7 inches over the last 100 years. The World Health Organization has predicted that climate change will cause an additional 250,000 deaths per year from 2030 to 2050 due to malnutrition, increased malaria, increased respiratory illness, heat-related illness, food issues due to crop losses, and increases in waterborne infectious diseases and vector-borne illness:

Their current recommendations include the following:

  • The entire health care community throughout the world must engage in environmentally sustainable practices that reduce carbon emissions.
  • Support efforts to mitigate and adapt to the effects of climate change.
  • Educate the public, their colleagues, their community, and lawmakers about the health risks posed by climate change

As guardians of human health, we must assume a more active role in avoiding these disastrous consequences—if not for our own well-being, but for that for our children and all future generations! These efforts could well begin with how we all vote in the coming election!

 

  • Crowley RA, et al. Climate change and health: A position paper of the American College of Physicians. [Published online ahead of print April 19, 2016]. Ann Intern Med. doi:10.7326/M15-2766.

 

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SUGAR DECEPTION = TOBACCO DECEPTION?

sugar

Previously I had presented information demonstrating how sugar has negative health consequences, often denied—for obvious reasons—by the sugar industry.

Now it has been brought to light how the sugar industry paid for and was closely involved in development of an influential literature review, published by the New England Journal of Medicine in 1967, that downplayed dietary sugar’s links to coronary heart disease while pointing the finger at fat and cholesterol intake, according to a report published September 12, 2016 in JAMA Internal Medicine.

The sugar industry’s funding and other participation were not disclosed in the 1967 articles, which had a major influence on dietary recommendations for sugar in the following decades, notes Dr C. E Kearns (University of California, San Francisco).

The literature review from almost 50 years ago—when conflicts of interest were not required—served as a lobbying tool for the industry and likely influenced the first dietary guidelines of the 1980s. It put the focus on dietary cholesterol and deflected sugar intake as a risk factor for heart disease. If the evidence had been fairly presented, the recommendations would have been to reduce both fat and sugar, not just saturated fat. Even today, the sugar industry, led by the Sugar Association, the industry’s Washington, DC–based trade association, steadfastly denies that there is a relationship between added sugar consumption and cardiovascular disease risk.

The present group (Kearns) analyzed previous internal documents from the Sugar Research Foundation (SRF), the precursor to the Sugar Association, that had become available in academic libraries and other publicly accessible locations. They also reviewed historical reports and statements made in early debates about health effects of sugar. According to those documents, the SRF set the journal’s review’s objective, contributed articles for inclusion, and received drafts. Kearns and colleagues describe finding documentation that the SRF paid two nutrition researchers, Dr D Mark Hegsted and Dr Robert McGandy (Harvard School of Public Health, Boston, MA), to conduct the literature review; the payments amounted to about $48,900 in 2016 dollars.

Also among the evidence of influence, they write, is correspondence from July 30, 1965, to Hegsted from SRF vice president John Hickson. In it, they report, Hickson emphasized the SRF’s objective for funding the review: “Our particular interest had to do with that part of nutrition in which there are claims that carbohydrates in the form of sucrose (table sugar) make an inordinate contribution to the metabolic condition, hitherto ascribed to aberrations called fat metabolism. I will be disappointed if this aspect is drowned out in a cascade of review and general interpretation.” Hegsted, the current report states, responded “We are well aware of your particular interest in carbohydrate and will cover this as well as we can”.

The Sugar Association responded to the recent report from Kearns and colleagues on September 12, 2016 with a statement: “We acknowledge that the Sugar Research Foundation should have exercised greater transparency in all of its research activities; however, when the studies in question were published, funding disclosures and transparency standards were not the norm they are today. Beyond this, it is challenging for us to comment on events that allegedly occurred 50 years ago and on documents we have never seen.”

I believe that Kearns and colleagues have found the “smoking gun,” having produced compelling evidence that a sugar trade association not only paid for but also initiated and influenced research expressly to exonerate sugar as a major risk factor for coronary heart disease.

The consequences of this deception are deeply disturbing.

First–and most obvious–is the misdirection of subsequent research and government efforts to improve heart health. Thanks largely to the reputation of Harvard and its research faculty, the publications sent other medical researchers down different paths, and retarded accurate evaluation of the role sugar plays in heart disease. These, and similar, research reports led to the belief that fat, not sugar, was the culprit, and Americans went on a low-and-no fat binge. What was particularly pernicious about the hundreds of new products designed to meet the goal of lowering fat content was the food industry’s preferred method of making low-fat offerings taste good: the addition of sugar—lots of sugar.

The discovery of the sugar industry’s role in twisting nutritional research results joins what we now know about the similar machinations of cigarette companies and fossil fuel industries.

Unfortunately, this type of subterfuge gives science itself a black eye. In the long-run, however, science is usually a self-correcting process, as evidenced by the recent investigation. But I must admit, 50 years is far too long!

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Sugary Drinks and Increased Risk of Cardiovascular Disease

 

sugary-drinks

American adults who drink one (or more) sugary drinks a day have a 27% greater increase in abdominal fat tissue compared with Americans who don’t, according to a new data analysis from the Framingham Heart Study in the journal Circulation.

Deposition of fat in this location is associated with the development of cardiovascular disease and type 2 diabetes, both of which produce adverse health consequences.

Although the exact biological mechanism is unknown, added sugars—especially fructose—may trigger insulin resistance and increase fat accumulation, which raises the risks for these serious consequences.

In this investigation, researchers enrolled 1,003 participants (mean age 45) from the Framingham Study’s Third Generation cohort and measured their quantity and quality of abdominal fat tissue at baseline and again 6 years later using C.A.T. scans. Subjects also reported their sugar-sweetened beverage and diet soda intake on a food frequency questionnaire.

Over a 6-year follow-up period—and after adjusting for participants’ age, gender, physical activity, body mass index, and other factors—abdominal fat tissue volume increased by:

  • 658 cm3 for non-drinkers and occasional drinkers (once a month or less than once a week)
  • 707 cm3 for frequent drinkers (once a week or less than once a day)
  • 852 cm3 for those who drank at least 1 beverage daily

The researchers concluded that, although age alone accounts for increasing fat, drinking sugar-sweetened beverages led to a significantly greater increase in abdominal fat tissue. In contrast, they observed no such association with drinking diet soda. Needless to say, observation of general dietary guidelines is also required to minimize accumulation of excess fat.

As a result, the researchers urged all people to be mindful of how many sugar-sweetened beverages they drink. To policy makers, this study adds more evidence to the growing body of research suggesting sugar-sweetened beverages may be harmful to health, providing arguments for public efforts to restrict such consumption.

Sugar-sweetened beverages are the largest contributor of added sugar intake in the United States. In 2001 to 2004, the usual intake of added sugars for Americans was 22.2 teaspoons per day, or an extra 355 calories. The American Heart Association recommends a limit of 100 calories per day of added sugars for most women and 150 calories per day for most men.

This information simply adds more support to the idea that sugar, in itself, is a dangerous dietary component. I will disclose more about this in the next blog.

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