Archive for the ‘News’ Category

Treating Mild Hypertension With Drugs May Be Misdirected

Thursday, September 25th, 2014

Treating Mild Hypertension With Drugs May Be Misdirected

 Veronica Hackethal, MD

September 23, 2014

Medscape 25.9.14

Treating mild hypertension with drugs has unclear benefit and adds exorbitant sums to national healthcare expenditures, experts write in an article published online September 14 in BMJ.

Thresholds for management need to be reexamined, and priorities should shift to lifestyle change, according to Stephen A. Martin, MD, assistant professor of medicine at the University of Massachusetts Medical School in Boston, and colleagues.

The article’s publication coincided with the Preventing Overdiagnosis conference held in Oxford in the United Kingdom. Oxford’s Centre for Evidence-Based Medicine and the BMJ‘s Too Much Medicine campaign sponsored the conference, which focused on reducing unnecessary care and waste of healthcare resources.

“The practical point for clinicians is that before you subject someone to lifelong medical therapy and its potential side effects, be sure that other elements like lifestyle changes have really been given a fair shot. That means don’t pull the trigger too quickly,” senior author Vikas Saini, MD, president of the Lown Institute and lecturer at Harvard Medical School, Boston, Massachusetts, told Medscape Medical News.

Evidence of Benefit Unclear

Dr. Saini outlined 3 main reasons for this assertion. First, there is no clear evidence that treating mild hypertension with medication has the same effect it does on moderate to severe hypertension in terms of reducing risk for cardiovascular disease and related health problems.

Roughly 40% of adults in the world have hypertension, about half of which is thought to be mild (140 to 159/90 to 99 mm Hg). More than 50% of people with mild hypertension receive medication.

During the last few decades, thresholds for diagnosing and treating hypertension have been lowered. The assumption has been that treating mild hypertension, even in those without risk factors such as diabetes or kidney disease, can reduce the risk for cardiovascular disease and death. Studies, however, have not born this out.

 

In addition, overmedication contributes to ballooning healthcare costs, the authors argue. The United States spends about 1% of its annual healthcare expenses and more than 30% of its national public health expenses treating hypertension, amounting to more than $32 billion annually.

Overmedication with antihypertensives also carries risks for increased harms to the patients, such as falls, hip fractures, drug-related hospital admissions, and poor physical and mental health self image.

Second, Dr. Saini said, inaccurate blood pressure measurement contributes to overdiagnosis.

“You want to be sure the readings that you’re basing treatment on are reliable and accurate, and that often means getting home and multiple readings,” Dr. Saini explained. For example, so-called white coat hypertension recorded at office visits is notoriously inaccurate, and automated cuffs and home-based methods may prove better prognostically.

Last, focusing on medication diverts resources away from investment in public health, Dr. Saini pointed out. Increased emphasis on system-wide lifestyle changes is needed, such as weight loss, decreasing salt intake, smoking cessation, reduced alcohol consumption, and increasing exercise levels.

“I think clinicians are frustrated, rightly so, by the fact that you can’t change the patients’ lifestyle with a 5- or 10-minute conversation in the office,” Dr. Saini said. “To ask doctors or the medical community to shoulder that burden is really unfair.”

The solution, he writes, is to rethink the approach, with a shift in resources and emphasis on public health rather than medical treatment.

“Doctors, public health workers, and community leaders really need to form an alliance. The path of least resistance of prescribing a drug feels good, but we have no idea if this really makes a difference,” Dr. Saini emphasized. “Thirty billion dollars is a lot of expense for something that makes no difference. Thirty billion dollars would go a long way if it was organized in a collaborative effort across society to make lifestyle changes easier for all of us.”

Some Clinicians Remain Skeptical

It may still take some convincing, however, before practicing clinicians come on board with these recommendations.

“The main challenge to implementing these changes is the dynamic nature of blood pressure and the likely reluctance of patients and doctors to risk taking patients off medicines that are not causing perceptible side effects,” Neda Laiteerapong, MD, assistant professor of medicine at the University of Chicago, Illinois, told Medscape Medical News. “These medications likely provide some security for the patients and doctors that the blood pressure is well-controlled.”

Emphasizing lifestyle change is in line with providing cost-effective, patient-centered care, Dr. Laiteerapong agreed, and could work for “some people,” such as those in their 40s and 50s who are healthier and do not have other chronic illnesses that interfere with exercise or self-care.

“However, many patients with hypertension are over 65, and many have chronic diseases which impede their ability to successfully implement lifestyle change,” Dr. Laiteerapong added, “While the article mentions that lifestyle change works, it’s truly very difficult for many people to implement the level of change necessary to make significant changes in blood pressure.”

 

Gerry Gajadharsingh writes:

 

Hypertension (high blood pressure) is something that many people worry about, sometimes with good cause. When I was a student the threshold for diagnosing hypertension was a diastolic of >100mmHg (the lower BP reading). Over the years the threshold has come down, for patients > 50, they are now considered hypertensive if the systolic (upper BP reading) is > 140mmHg and Diastolic > 90mg. This has pushed a lot more patients into the hypertensive category. The majority of those patients (>80%) are classified as having “essential” hypertension, a bizarre choice of word as we do not need to have high blood pressure and we certainly don’t want it! What it means is that there is often no “discernable cause”.

 

The authors above are rightly highlighting, backed by research, that perhaps we shouldn’t medicalise so many patients but first attempt to help patients understand how their lifestyle choices may well be causing their hypertension. As more than 50% of people with mild hypertension receive medication, that’s a lot of medication, potential side effects, potential drug interactions and a lot of money!!

 

It is possible to help patients manage their blood pressure with both life style modification and with targeted non-invasive intervention, such as changing their breathing pattern and mindfulness techniques. Vascular tone is influenced by the autonomic (subconscious) nervous system, helping peoples to change their breathing behaviour, increasing their Heart rate variability by decreasing sympathetic over activity, in conjunction with weight management dietary change or other lifestyle interventions can prove wonders. It is unrealistic to expect GP’s to burden this responsibility, even if they had the time and skills to do it. So the onus needs to be on patients and other clinicians, who have the time and necessary skills to parent GP’s in helping patients make these changes, assuming patients want to change in the first place!

Heart surgeon declares on what really causes heart illness

Friday, June 27th, 2014

Heart surgeon declares on what really causes heart illness

 Tuned Body

8.12.13

by Dr. Dwight Lundell – from: PreventDisease

We physicians with all our experience, know how and authority often acquire a rather large selfishness that tends to make it hard to accept we are wrong. So, here it is. I openly admit to being mistaken. As a heart surgeon with 25 years experience, having done more than 5,000 open-heart surgeries, today is my day to right the wrong with medical and scientific proof.

I trained for many years with other prominent physicians labelled “opinion makers.” Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol.

The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice.

It Is Not Working!

These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.

The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.

Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.

Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year.

Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.

Inflammation is not complicated — it is quite simply your body’s natural defence to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process,a condition occurs called chronic inflammation. Chronic inflammation is just as harmful as acute inflammation is beneficial.

What thoughtful person would willfully expose himself repeatedly to foods or other substances that are known to cause injury to the body? Well, smokers perhaps, but at least they made that choice willfully.

The rest of us have simply followed the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity.

Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine.

What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods.

Take a moment to visualize rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding. you kept this up several times a day, every day for five years. If you could tolerate this painful brushing, you would have a bleeding, swollen infected area that became worse with each repeated injury. This is a good way to visualize the inflammatory process that could be going on in your body right now.

Regardless of where the inflammatory process occurs, externally or internally, it is the same. I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing the body to respond continuously and appropriately with inflammation.

While we savor the tantalizing taste of a sweet roll, our bodies respond alarmingly as if a foreign invader arrived declaring war. Foods loaded with sugars and simple carbohydrates, or processed with omega-6 oils for long shelf life have been the mainstay of the American diet for six decades. These foods have been slowly poisoning everyone.

How does eating a simple sweet roll create a cascade of inflammation to make you sick?

Imagine spilling syrup on your keyboard and you have a visual of what occurs inside the cell. When we consume simple carbohydrates such as sugar, blood sugar rises rapidly. In response, your pancreas secretes insulin whose primary purpose is to drive sugar into each cell where it is stored for energy. If the cell is full and does not need glucose, it is rejected to avoid extra sugar gumming up the works.

When your full cells reject the extra glucose, blood sugar rises producing more insulin and the glucose converts to stored fat.

What does all this have to do with inflammation? Blood sugar is controlled in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels.

While you may not be able to see it, rest assured it is there. I saw it in over 5,000 surgical patients spanning 25 years who all shared one common denominator — inflammation in their arteries.

Let’s get back to the sweet roll. That innocent looking goody not only contains sugars, it is baked in one of many omega-6 oils such as soybean. Chips and fries are soaked in soybean oil; processed foods are manufactured with omega-6 oils for longer shelf life. While omega-6′s are essential -they are part of every cell membrane controlling what goes in and out of the cell — they must be in the correct balance with omega-3′s.

If the balance shifts by consuming excessive omega-6, the cell membrane produces chemicals called cytokines that directly cause inflammation.

Today’s mainstream American diet has produced an extreme imbalance of these two fats. The ratio of imbalance ranges from 15:1 to as high as 30:1 in favor of omega-6. That’s a tremendous amount of cytokines causing inflammation. In today’s food environment, a 3:1 ratio would be optimal and healthy.

To make matters worse, the excess weight you are carrying from eating these foods creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar. The process that began with a sweet roll turns into a vicious cycle over time that creates heart disease, high blood pressure, diabetes and finally, Alzheimer’s disease, as the inflammatory process continues unabated.

There is no escaping the fact that the more we consume prepared and processed foods, the more we trip the inflammation switch little by little each day. The human body cannot process, nor was it designed to consume, foods packed with sugars and soaked in omega-6 oils.

There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation- causing omega-6 fats like corn and soybean oil and the processed foods that are made from them.

One tablespoon of corn oil contains 7,280 mg of omega-6; soybean contains 6,940 mg. Instead, use olive oil or butter from grass-fed beef.

Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labelled polyunsaturated. Forget the “science” that has been drummed into your head for decades. The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today.

The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers.

What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.

Gerry Gajadharsingh writes:

 This is powerful stuff, at last an eminent medical consultant willing to own up to the “bad” advice that the population have been receiving over the past 20 years or so, well done Dr Lundell. But to be fair that’s the problem with science, there’s always an amount of “conflicting evidence” and it can often depend on whose voice is more powerful. But there should always be an element of common sense, as far as our  food choice is concerned, try your best to stick to nature, is it natural to process/liquidize fruit, to turn it into juice/smoothies, just so that we can drink it (now understanding that a glass of juice will contain so much sugar it pushes you over the WHO sugar guidelines!!!)

 

 

Stigma of mental ill health is ‘worse than the illness’

Thursday, June 19th, 2014

Stigma of mental ill health is ‘worse than the illness’.

The Independent Thursday 18th October 2012 Jeremy Laurance

It is the single biggest cause of disability in the Western world but many sufferers say the stigma attached to it is worse than the illness itself, according to researchers.

While celebrity sufferers who speak about their depression are hailed as heroes, ordinary citizens are shunned, taunted and abused.

An international study of more than1,000 sufferers in 35 countries has found that three quarters said they have been ostracised by other people leading them to avoid relationships, applying for jobs and contacting friends. Discrimination is leading may to put off seeking treatment with a subsequent worsening of their condition.

Drugs and psychotherapy can help 60- 80 % of people with depression but only half get treatment and only 10% receive treatment that is effective- at the right dose, for long enough and with the right kind of therapy. The international study published in The Lancet found that levels of discrimination were similar to those for schizophrenia revealed in a similar study three years ago. Professor Graham Thornicroft, head of health service and population research at the institute of psychiatry said: “We have a major problem here. Non disclosure is an extra barrier- it means people don’t seek treatment and don’t get help.”

While public confessions of depression by well known people including tennis champion Serena Williams the US actress Kirsten Dunst and chat show host Stephen Fry were increasing, abuse of sufferers was also widespread. The Norwegian Prime minister, Kjell Bondevik, attracted worldwide approval when he relinquished power for three weeks to his deputy in 1998 while he recovered from an episode of depression. He was subsequently re elected.

In contrast, professor Thornicroft described the case of a woman who had dog faeces posted through her door because neighbours wanted out and another in which police halted an interview with a man whose flat had been burgled when they learnt that he had been in a psychiatric hospital.

“Our findings show Discrimination is widespread and almost certainly acts as a barrier to an active social life and having a fair chance to get and keep a job”, he said.

“The Governments Time to Change campaign launched in 2008 aimed at reducing discrimination against people with mental illness had proved to have a “modest but significant” impact, he added.

In a separate study, researchers have found that the 2008 economic crash led to deterioration in the mental health of men- but not women. Anxiety and depression increased markedly among men in the three years following the crash, but women escaped largely unscathed. Rising unemployment and falling income are not to blame, the researchers say. Instead, job insecurity is thought to be the cause. Mental ill health among men rose from 13.7% in 2008 to 16.4 % in 2009 before falling back to 15.5% in 2010, according to the study published in the journal BMJ Open.

Men derive much of their social status from their occupation and are still the main wage earners in most families. They are becoming more mentally unstable because of the fear of losing their jobs in the recession. The authors from the social and public health sciences unit in Glasgow say that while women’s mental health appeared to change little in the period it may have deteriorated since due to job cuts in the public sector.

 

Gerry Gajadharsingh writes:

 About 20 years ago I was invited to the House of Lords to an event on work place absence, where at the time Low Back Pain was given as the single most important reason for time away from the work place. Fast track 20 years and I was invited back to a similar event where now “Stress” is the single most important reason for time away from work. I actually don’t think anything has changed except clinicians and patients are more open to the idea that “stress” can adversely affect our physiology and cause an array of health manifestations. The important thing is to help the patient develop strategies that improve their coping mechanisms and this needs to be done on an individual basis, simply because we are all different! The article above suggests that we still have a long way to go before many more people simply accept that our minds play a major part in our illnesses.

 

 

Skimmed milk ‘doesn’t stop toddlers getting fat’

Tuesday, April 9th, 2013

Skimmed milk ‘doesn’t stop toddlers getting fat’

Jenny Hope Medical Correspondent

The Daily Mail 19 March 2013

 

 

Parents who give their toddlers skimmed milk to prevent them from gaining weight may be wasting their time. A study found that two year olds who drank full fat milk put on fewer pounds than those on low fat. Academics believe this is because full fat keeps them fuller for longer, and they eat less as a result.

The US study concluded that the type of milk given to children ‘may not matter that much’ despite fears the obesity epidemic is being fuelled by diets high in fat.

Researchers at the University Of Virginia School Of Medicine found two-year-olds who drank mainly low-fat and skimmed milk were 57 per cent more likely to become overweight by the age of four. But the average weight of children drinking full-fat milk was lower over the same period.

Professor Mark DeBoer, who led the research, said: ‘We assumed the study would show that children drinking low-fat and skimmed milk would be helped to keep their weight down, but this was not the case.

‘If you are going to drink milk, and we strongly back the importance of drinking milk at a young age, it doesn’t seem to matter that much which type it is.’

In the US, the American Academy of Pediatrics and the American Heart Association recommend all children drink low-fat or skimmed milk after the age of two to ward off obesity.In contrast, British children under five are not advised to drink skimmed milk – which has virtually all the fat removed – because they need the extra energy for growth.The US study asked 11,000 parents what type of milk their children drank at aged two and four: skimmed; one per cent semi-skimmed; two per cent milk fat; full-fat, or soy.

Heavier children were more likely to drink skimmed and semi-skimmed milk, with 14 per cent of heavy two-year-olds and 16 per cent of heavy four-year-olds drinking it, compared with nine per cent of normal weight two-year-olds and 13 per cent of normal weight four-year-olds.

Professor DeBoer said parents may be acting from the best motives by choosing low-fat milks, but milk fat may increase a feeling of fullness so reduce the appetite for other high calorie foods. He said: ‘Physicians don’t have much time to advise parents worried about their children putting on weight, so they may be better off sticking to advice we know works.

 

Gerry Gajadharsingh writes: When are the powers to be going to come clean and advise patients that following low fat diets are NOT what you need to do? Actually the title should be eating low fat makes you put on weight!

Sugary Drinks May Explain 180,000 Deaths Worldwide Each Year

Tuesday, April 9th, 2013

Sugary Drinks May Explain 180,000 Deaths Worldwide Each Year

Marlene Busko

Mar 20, 2013

 

NEW ORLEANS — A large, international epidemiologic study reports that slurping back large amounts of sugary beverages was associated with an increased body-mass index (BMI), which in turn was linked with BMI-related deaths from diabetes, cardiovascular disease (CVD), and cancer.

Specifically, the researchers found that in 2010, 132,000 deaths from diabetes, 44,000 deaths from CVD, and 6000 deaths from cancer in the world could be attributed to drinking sugar-sweetened soft drinks, fruit juice, or sports beverages.

The study byGitanjali Singh, PhD, from Harvard School of Public Health, Boston, Massachusetts, and colleagues was reported at EPI|NPAM 2013, the Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.

“It is a [surprisingly] large number of deaths — tens of thousands of deaths — that are being caused by consuming sugary beverages,” Dr. Singh commented to Medscape Medical News. Three quarters of these BMI-related deaths were from diabetes, which “suggests that limiting sugary-beverage intake is an important step in reducing diabetes deaths,” she noted.

“Uphill Battle” to Change Patient Habits, Public Policy

The study reinforces the need for clinicians to encourage patients to drink fewer sugary beverages, Dr. Singh said. In addition, even though “it’s certainly an uphill battle [to change public policy] — it’s one that…physicians, cardiologists, public-health scientists, [and] policy makers…really need to advocate for and show support for,” she noted.

As part of the Global Burden of Disease study, the researchers obtained data from 114 national dietary surveys, representing more than 60% of the world’s population.

Based on data from large prospective cohort studies, they determined how changes in consumption of sugary drinks affected BMI, and next, how elevated BMI affected CVD, diabetes, and 7 obesity-related cancers (breast, uterine, esophageal, gallbladder, colorectal, kidney, and pancreatic cancer). Using data from the World Health Organization, they calculated the number of deaths from BMI-related CVD, diabetes, and cancer for men and for women aged 20 to 44, 45 to 64, and 65 years and older.

Average sugary-drink consumption varied tremendously — from less than 1 drink (8 oz) a day in elderly Chinese women to more than 5 drinks (40 oz) a day in younger Cuban men.

Most deaths (78%) from excess sugary drinks were in low- and middle-income countries.

Mexico, which has one of the world’s highest per capita rates of drinking sweetened drinks, had the greatest number of deaths related to this risk factor: 318 deaths per million adults.

In contrast, Japan, with one of the lowest per-capita rates of imbibing these beverages, had the smallest number of deaths attributable to this risk factor: about 10 deaths per million adults.

In 2010, drinking sugar-sweetened beverages was associated with about:

  • 38,000 deaths from diabetes in Latin American and Caribbean countries.
  • 11,000 deaths from CVD in Eastern- and Central-Eurasian countries.
  • 25,000 deaths in the United States.

“Sugar-sweetened beverages are a major cause of preventable deaths due to chronic diseases, not only in high-income countries, but also in low and middle-income countries,” the group concludes.

Bottom Line: Advise Patients to Avoid Sugary Drinks

“The evidence base that sugar-sweetened beverages are associated with excess weight gain is well established; what these investigators have done is to take it a step further by saying the excess weight gain that is attributable to sugary drinks actually increases the risk of death from diabetes, CVD, and cancer,” American Heart Association(AHA) spokesperson Rachel K. Johnson, PhD, from the University of Vermont, Burlington, commented.

Study strengths include its large scope, but since it was an epidemiologic study, it does not demonstrate cause and effect, Johnson noted. Nevertheless, “it is certainly a [biologically] plausible association, and we should take it seriously,” she added.

According to Dr. Johnson, “The bottom line is to [advise patients to] avoid sugar-sweetened drinks, [since we have] more and more evidence that it’s not a good choice.”

 

It is “particularly problematic” that satiety mechanisms don’t kick in with beverages in the same way as with solid foods. “If you have a sugary drink at 4 o’clock, you’re not as likely to cut back on what you eat for dinner in the same way you would if you’d had a snack of solid food at 4 o’clock,” she said.

The AHA recommends that adults don’t exceed 450 calories a day or 36 oz a week from sugar-sweetened beverages. In a 2012 statement position statement, the AHA and American Diabetes Association stated that nonnutritive artificial sweeteners can be a tool to help people lower their added sugar and calorie intake, as long as they don’t eat extra calories to compensate for the lower calories in the diet drinks.

The authors have disclosed no relevant financial relationships.

EPI|NPAM 2013. March 19–22, 2013. Abstract MP22.

 

Gerry Gajadharsingh writes:

Note this research includes fruit juices, whilst a little fruit is good for you, that means the whole fruit including the fibre which helps to slow down the fructose (fruit sugar) release, drinking fruit juices and smoothies is not what we recommend!

Multivitamins May Lower Cancer Risk in Men

Thursday, November 1st, 2012

Multivitamins May Lower Cancer Risk in Men

Medscape Today News

17th October 2012

11th Annual American Association for Cancer Research (AACR) International Conference on Frontiers in Cancer Prevention Research

 

The daily use of multivitamins may reduce the risk for cancer in men, according to the results of a very large randomized trial.

After about 11 years, multivitamin use resulted in a modest but statistically significant reduction — specifically, an 8% reduction in total cancer incidence.

In an analysis that separated prostate cancer from all other cancers, “we did not see an effect for prostate cancer, but there was a 12% reduction in total cancers which was significant,” said lead author John Michael Gaziano, MD, MPH. He was speaking at a press briefing ahead of a presentation at the Annual American Association for Cancer Research (AACR) Frontiers in Cancer Prevention Research meeting.

The study has also been published early online in the Journal of the American Medical Association to coincide with the meeting.

“Cancer mortality also went in the right direction — a 12% reduction which wasn’t quite statistically significant but certainly a consistent finding,” said Dr. Gaziano, a researcher at Brigham and Women’s Hospital, Center for Older Adult Health, Boston, Massachusetts.

“Our main message is that the main reason to take a multivitamin is for nutritional deficiencies but it certainly appears that there may be a modest benefit in preventing cancer in men over the age of 50,” he said.

A number of trials of individual vitamins, administered at high doses, have not shown any effect at preventing cancer, Dr. Gaziano explained.

Observational studies have also not provided evidence of an association between multivitamin use and a reduction in cancer incidence or mortality.

However, the current study is unique in a number of ways, the first being that it is the only large-scale placebo-controlled trial evaluating a multivitamin in the prevention of cancer.

It is also of long duration, he said. “This effort was 17 years in the making, from the time we wrote the first protocol and we have 11 years of follow up, with up to 14 years of treatment for some of the participants.”

In addition, Dr. Gaziano pointed out that this study was well controlled. The participants who were randomized to the multivitamin arm were all taking the exact same brand and formulation (Centrum Silver), which has not necessarily been the case in other studies.

Conflicting Results

Previous studies have reported conflicting results. As reported by Medscape Medical News, 2 studies evaluating the association of multivitamins and breast cancer found opposite results — one study found an increased risk while the other found that multivitamins decreased the risk.

Another study reported more neutral results, in that multivitamin use had no influence on the risk for common cancers, cardiovascular disease, or overall mortality.

The lead author of that study, Marian L Neuhouser, MD, commented at that time that the “main message of our study is that postmenopausal women who take a multivitamin don’t increase their risk for cancer or cardiovascular disease, but they don’t decrease it either.

“These multivitamins are having no effect with regard to these particular disease outcomes,” said Dr. Neuhouser, who is from the Fred Hutchinson Cancer Research Center, Seattle, Washington.

Reduction in Total Cancers

The data in the current study was drawn from the Physicians’ Health Study II, a large-scale, randomized, double-blind, placebo-controlled trial that included 14, 641 male US physicians who were 50 years or older when the study began. The cohort included 1312 men with a history of cancer. The multivitamin study began in 1997, with treatment and follow-up that continued through June 1, 2011.

The cohort included a large proportion of former smokers (40.0%) and a very low proportion of current smokers (3.6%) with a high rate of current aspirin use (77.4%).

“This was a population of healthy physicians,” Dr. Gaziano said. “Over two thirds of them exercised regularly and only 4% smoked.”

Adherence to the protocol was high in both the multivitamin and placebo group. At 4 years, it was 76.8% (vitamin) and 77.1% (placebo), P = .71; and at 8 years, adherence was 72.3% (vitamin) and 70.7% (placebo), P = .15. It remained high even at the end of the follow-up period, at 67.5% and 67.1%, respectively (P = .70).

During the study period, a total of 2669 men developed cancer, including 1373 cases of prostate cancer and 210 cases of colorectal cancer. A total of 2757 participants (18.8%) died during follow-up, and this included 859 (5.9%) from cancer.

Their results showed that men taking a daily multivitamin had a statistically significant reduction in the incidence of total cancer, as compared with placebo (17.0 and 18.3 events, respectively, per 1000 person-years; hazard ratio [HR], 0.92; P = .04).

However, when the cancers were considered separately, there was no significant effect. There was no effect of the daily multivitamin on prostate cancer (multivitamin and placebo groups, 9.1 and 9.2 events per 1000 person-years; HR, 0.98; P = .76), colorectal cancer (1.2 and 1.4 events per 1000 person years; HR, 0.89; P = .39), or any other site-specific cancers.

Dr. Gaziano and colleagues noted that the total cancer rates in this cohort were probably influenced by the increased surveillance for prostate-specific antigen (PSA) and subsequent diagnoses of prostate cancer during the last 1990s.

“We had included participants with a prior history of cancer and we had prespecified an analysis that we would do, and there is an appearance of a stronger effect in those with a prior cancer,” he said.

Among men with a baseline history of cancer, daily multivitamin use was associated with a reduction in total cancer (HR, 0.73; P = .02). However, this reduction was not significantly different from the cohort without a cancer history (HR, 0.94; P = .15; P for interaction = .07).

“We are continuing more analyses, looking at the nutritional status of the individuals,” Dr. Gaziano said. “We hope to be able to continue following this cohort, some of whom we have been following for 30 years, so we can see the long term effects.”

Researchers from the Linus Pauling Institute at Oregon State University, Corvallis, who have been studying related issues, commented that this data “conclusively shows that multivitamins are safe to take, help fill important nutritional gaps, reduce cancer risk and in turn will help cut health care costs.”

“An 8 percent drop in overall cancer rates is not small,” said Balz Frei, PhD, professor and director of the Linus Pauling Institute, in a statement.

“Given that more than 1.6 million new cancer cases are diagnosed in the U.S. each year, this translates into about 130,000 cancers prevented every year, and with it all the health care costs and human suffering,” commented Dr. Frei, who was not involved in the study.

Dr. Frei also pointed out that the effect might be even higher in other population groups than seen in this study. “And it’s worth noting that the research was done with 14,600 physicians,” Dr. Frei said. “This highly-educated group has a better diet, knowledge base and health habits than the average person, so it’s reasonable to believe that the impact of multivitamin use in the general population will be even greater.”

11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, Presented October 17, 2012.

The study was supported by grants from the National Institutes of Health and the BASF Corporation. Dr. Gaziano reports investigator-initiated research funding from the NIH, the Veterans Administration, and the BASF Corporation; assistance with study agents and packaging from BASF Corporation and Pfizer (formerly Wyeth, American Home Products, and Lederle); and assistance with study packaging provided by DSM Nutritional Products Inc. (formerly Roche Vitamins). Several other coauthors also report relationships with industry as noted in the paper.

JAMA. 2012. Published online October 17, 2012.

 

Gerry Gajadharsingh writes:

 

So you see the problems of research! Sometimes conflicting research comes up. The American Physicians Health Study is a study following a very large group of American Physicians over many years, I also present some of this research to back up the science behind Metabolic Balance. Interestingly the multivitamin /mineral complex used was a standard OTC low dose following Recommended Daily Allowance (RDA), for example Vitamin C at 60mg (100% RDA), Magnesium (13% RDA) and Zinc (73% RDA), amongst others.

 

RDA was developed to ward of deficiency disease, if you take in less than 60mg of Vitamin C a day eventually you will develop scurvy, the plague of sailors in times gone by. This is vastly different to saying that 60mg is all you need! I am amazed that even at this low dose the reduction in overall male cancer (>50 years) was 12% (excluding prostate cancer). I expect that in years to come research will become more convincing with the use of optimal levels of nutritional supplementation (not just vitamins and minerals) in decreasing the incidence of diseases, not just cancer. Of course the main stay of keeping healthy should be great nutrition, with supplements doing just that, supplementing your diet.

Simvastatin: updated advice on drug interactions – updated contraindications

Wednesday, October 17th, 2012

The Medicines and Healthcare products Regulatory Agency (MHRA)

 Drug Safety Update

 Simvastatin: updated advice on drug interactions – updated contraindications

 

Article date: August 2012

 

We have previously communicated on the increased risk of myopathy associated with use of high-dose simvastatin (80 mg daily) – see Drug Safety Update May 2010.

Considering the risk of myopathy associated with simvastatin, recent analysis of clinical trial data, spontaneously reported cases and drug- drug interaction studies has resulted in further changes to the simvastatin prescribing information.

The changes include contraindications to concomitant use with certain medicines and maximum dose recommendations when simvastatin is taken with a number of other medicines, as these interactions may increase plasma concentrations of simvastatin which is associated with an increased risk of myopathy and/or rhabdomyolysis. Key points to note are that:

  • Simvastatin is now contraindicated with ciclosporine, danazol and gemfibrozil
  • The maximum recommended dose for simvastatin in conjunction with amlodipine or diltiazem is now 20 mg/day

A full updated listing of all the interactions is provided in the table below.

Drug interactions associated with increased risk of myopathy/rhabdomyolysis

Interacting agents Prescribing recommendations
Itraconazole

Ketoconazole

Posaconazole

Erythromycin

Clarithromycin

Telithromycin

HIV protease inhibitors (eg, nelfinavir)

Nefazodone

Ciclosporin

Danazol

Gemfibrozil

Contraindicated with simvastatin
Other fibrates (except fenofibrate) Do not exceed 10 mg simvastatin daily
Amiodarone

Amlodipine

Verapamil

Diltiazem

Do not exceed 20 mg simvastatin daily
Fusidic acid Patients should be closely monitored. Temporary suspension of simvastatin treatment may be considered.
Grapefruit juice Avoid grapefruit juice when taking simvastatin

 

 

Gerry Gajadharsingh writes:

 

This is slightly worrying, Many of my male musculoskeletal patients concurrently take statins. It is difficult to know sometimes if the statin they are taking contributes to their pain, certainly elevation of the muscle enzyme creatine kinase (CK) requested as a blood test may be helpful. However data is now emerging that this common statin is causing increasing problems, hence the guidance to make sure you are not taking more than 20mg especially if you are taking other medications for blood pressure and even common antibiotics such as Erythromycin. Patients also find it amazing that even grapefruit is contraindicated!

 

Sitting down increases risk of Type 11 Diabetes, CVS events and death

Wednesday, October 17th, 2012

Sitting down increases risk of Type 11 Diabetes, CVS events and death

Medscape News

October 15, 2012 (Leicester United Kingdom) — The more time people spend sitting, the greater their risk of diabetes, cardiovascular events, and death, a new meta-analysis has shown [1]. This is the first research to systematically quantify the strength of association between sedentary behavior–beyond just TV viewing–and health outcomes and shows a particularly consistent relationship for diabetes, say Dr Emma G Wilmot (University of Leicester, UK) and colleagues in their paper in the November 2012 issue of Diabetologia.

Wilmot says that a number of important messages have emerged from the research. “People don’t think about sitting as being dangerous, and it’s quite a change, having to think, ‘how can I reduce my sitting?’ rather than just ‘how much exercise can I do?’ We’ve traditionally been focused on making sure we meet the physical-activity guidelines of 30 minutes per day, but with that approach we’ve overlooked what we do with the other 23 and a half hours in the day. If you sit for the rest of the day, that is going to have an impact on health, and that’s essentially what our meta-analysis shows,” she told heartwire .

She stresses, however, that this does not mean that exercise is not important. “That’s obviously not the case. There’s a wealth of data showing that physical activity is important, but if people are spending a large percentage of their time sitting, they need to start thinking about how they can reduce this.”

And this message applies across the world, says Wilmot, who says she has had journalists calling her from as far afield as Canada, Chile, India, Russia, South Africa, and the US.

She and her colleagues add that much more research is needed to figure out how best to quantify and standardize measures of sedentary behavior and to formulate guidelines. “At the moment, we don’t have enough of an evidence base to be able to give very specific recommendations about how much to reduce sitting time by. We need intervention studies to give us some guidance on what approach we should take.” She and her colleagues are now running a study in 200 young people at increased risk of diabetes, which they expect to report next year and which they hope will add to this evidence base.

Greatest vs Least Sedentary Time Doubles Risk of Diabetes

Wilmot and colleagues say the hazards of high levels of sitting were first highlighted in the 1950s, when a twofold increase in the risk of an MI was identified in London bus drivers compared with active bus conductors. But since then, the “potentially important distinction” between sedentary (sitting) and light-intensity physical activity has been “largely overlooked” in research, they observe.

“The opportunities for sedentary behavior in modern society, such as watching television, sitting in a car, or using the computer, are ubiquitous,” they add, stating that estimates have put the time the average adult spends in sedentary pursuits at around 50% to 60% of their day.

For their review, the researchers searched for terms related to sedentary time and health outcomes. They combined the results of 18 studies including a total of 794 577 participants. The data were adjusted for baseline event rate and pooled using a random-effects model.

The greatest sedentary time compared with the lowest was associated with a doubling of diabetes (relative risk 2.12), around a 2.5-fold increase in the risk of cardiovascular events (RR 2.47), a 90% rise in risk of cardiovascular death (hazard ratio 1.90) and a 49% higher risk of all-cause mortality (HR 1.49). Based on the pooled effects, all of these findings were significant.

Further statistical analysis showed that the predictive effects were significant only for diabetes, which means the reproducibility of the diabetes finding was greater, suggesting this is the “most robust” result, Wilmot noted.

“People don’t realize that doing just small amounts of activity–it doesn’t even need to be a proper walk–are important,” she says. “If you are having a chat with a friend at your desk or the phone rings, stand up and chat. Just these small changes could make a big difference.”

Specific Reasons Why Sitting Ups Risk of Diabetes

Wilmot explained to heartwire that there appear to be specific reasons why sitting too long can be particularly deleterious in terms of diabetes. “Sitting seems to have an immediate effect on how our bodies metabolize glucose. When we sit, our muscles are not used, and we quickly become more insulin resistant.” Studies have shown that people who sit after eating have 24% higher glucose levels than people who walk very slowly after a meal, she says.

It is also known that there are some individuals who are genetically predisposed to the adverse effects of sitting, including those who are susceptible to diabetes, “so it might be especially important for these people to avoid prolonged sitting,” she observes. The exact metabolic pathways involved are not known, “but what we do know is that when rats have their hind legs immobilized, there is a reduction in lipoprotein lipase, a key regulator of metabolic health.”

Further studies in this area are required, she says, and future diabetes-prevention programs should consider promoting reduced sedentary behavior–including environmental restructuring to promote less sitting–alongside more traditional lifestyle behaviors such as increased physical activity and dietary change.

Also needed is research on how best to quantify sitting using devices called accelerators–which can calculate how long people sit for–as well as work on how to standardize measures of sedentary time. This will include looking at the feasibility of reducing sitting time too, by employing simple concepts such as standing or “walking” desks with treadmills or gadgets that people wear on their waist and that vibrate when the user has been sitting continuously for 40 minutes.

 

Gerry Gajadharsingh writes:

Here’s a good tip, do 5 minutes of resistance based exercise to activate your glucose receptors before eating followed by a short (gentle and slow) walk after eating. Be aware that lots of cardio exercise may also counter productive as it keeps us in carb burning energy pathways and pushes up our insulin response.

 

Use of Complementary & Alternative Medicine (CAM) in Cancer Patients

Wednesday, October 17th, 2012

Use of Complementary & Alternative Medicine (CAM) in Cancer Patients

October 16, 2012 (Albuquerque, New Mexico) — A large percentage of cancer patients use complementary and alternative medicine (CAM) for a wide variety of reasons. Because some of these therapies can interfere with conventional treatments, such as chemotherapy, it is imperative that healthcare providers know everything their patients are using.

Oncology nurses tend to underestimate their patients’ use of CAM, according to a study presented here at the 9th International Conference of the Society for Integrative Oncology.

“From multiple surveys, we know that the primary reason that patients aren’t sharing information about CAM use is because nobody has asked them,” said Lorenzo Cohen, PhD, professor and director of the integrative medicine program at the University of Texas M.D. Anderson Cancer Center in Houston.

Dr. Cohen presented the results of a study designed to evaluate the effect of a brief intervention for nurses on communication about CAM. The primary aim of the study was to make nurses aware of the importance of asking their patients about CAM. A secondary aim was to assess the use of CAM in community settings; most research to date has been done in academic settings,” he explained.

Concern About Interactions

Cancer patients often use over-the-counter medications and are increasingly using CAM, as previously reported by Medscape Medical News. This is particularly true in older adults, who make up the largest population of cancer patients and have high rates of polypharmacy.

Interactions between drugs and CAM are a real concern, William Douglas Figg Sr., PharmD, MBA, senior scientist and head of the clinical pharmacology program and molecular pharmacology section at the Center for Cancer Research, National Cancer Institute (NCI), in Bethesda, Maryland, previously explained. “We know that some [CAM] agents can increase metabolism or decrease metabolism,” he said. “Some can alter absorption. These might alter the anticancer agents we are giving.”

Patient and Nurse Perspectives

Dr. Cohen and colleagues conducted their multisite randomized trial through the Community Clinical Oncology Program (CCOP) Research Base at the M.D. Anderson Cancer Center. This NCI-funded program prepares cancer control and prevention trials, which are then made available to a national network of CCOP sites and independent Main Member sites.

Initially, 175 nurses were recruited to the trial, as were 699 patients who completed a questionnaire about CAM use, communication, and knowledge (preintervention patients). Two months later, another 650 patients were recruited and completed the questionnaire (postintervention patients).

Nurses in the intervention group viewed a weekly 20-minute video that discussed the definitions of CAM, issues of patient use, the importance of discussing CAM, and the legal ramifications of not doing so. A resource list on how to access information about CAM was provided to the nurses in the intervention group and to those in the control group.

About 40% of patients reported that they used some type of CAM (excluding spiritual practices such as prayer) after their cancer diagnosis. “This number is somewhat low,” Dr. Cohen noted. “We are still doing analyses to really be sure about it, but it does seem that in community settings and in the regions where the study was conducted, it is somewhat lower.”

The main reasons patients gave for using CAM was that they found it beneficial (70%) and it addressed emotional and spiritual aspects (62%) related to their disease. Some patients also reported that it helped their immune system and alleviated adverse effects.

The main reasons patients gave for not using CAM given were a lack of information about it and skepticism about its benefits.

At 2-month follow-up, more nurses in the intervention group reported asking about CAM use than nurses in the control group (odds ratio [OR], 4.2; P < .005), and reported asking more of their last 5 patients about CAM use (P =.003).

However, when preintervention and postintervention patients reported on being asked about CAM use, there was no significant difference (OR, 1.6; P > .010)

Underestimation of CAM Use

There was a huge misperception when nurses were asked what percentage of their patients used CAM. “The majority thought that it was 1% to 25%, so no more than a quarter. In fact, we know that close to one half of patients reported using some type of CAM,” Dr. Cohen noted.

Interestingly, the researchers found that there was a high degree of personal CAM use among nurses.

CAM use in community-based oncology patients is relatively high, but there was an underestimation of its use by the oncology nurses, he concluded. Although more nurses in the intervention group reported asking about CAM use than in the control group, when the same element was assessed in patients, the effect was more modest, Dr. Cohen reported.

This is something that needs to be better understood, he added, and future studies should include other members of the healthcare team, including physicians.

9th International Conference of the Society for Integrative Oncology (SIO). Presented October 10, 2012.

 

Gerry Gajadharsingh writes:

 

A diagnosis of cancer is always traumatic for patients and their families. It is good to know that of almost 50% of all cancer patients using CAM, 70% found it beneficial, with 62% finding the emotional support offered by CAM very useful. The diagnostic procedures necessary to confirm cancer can sometimes be painful and traumatic to some patients, especially biopsy, receiving the dreaded diagnosis traumatic enough, never mind the treatment offered which may include surgery, radiotherapy or chemotherapy. CAM clinicians experienced in helping patients as an adjunct to their medical intervention can often help with the “non-medical factors”, nutritional, management of anxiety, overall well-being, pain control and general support. Many oncology centres are welcoming adjunct therapies but I think it only sensible that patients inform their cancer specialists of CAM treatment they are receiving, especially OTC nutritional and herbal supplements which may effect any potential medical interventions. Lifestyle factor modification, such as alcohol, smoking, caffeine, high glycaemic load carbohydrate diets, stress management etc., can sometimes play its part in cancer care and preventive strategies.

Pushy Parents are told to Slow down and let children thrive

Wednesday, October 17th, 2012

Pushy Parents are told to Slow down and let children thrive

Eton Master warns pressure can be damaging

Greg Hurst Education Editor. The Times Saturday October 13th 2012

Pushy parents, “tiger” mothers, turbo charged fathers- prepare to meet your nemesis. Eton College is in the vanguard of a new movement seeking to tell teachers, teenagers and especially their parents to slow down, even to embrace a little idleness.

The message is aimed at families so preoccupied with theirs child’s development that they micromanage free time, ferrying them from super selective schools to tutors, music teachers and sports clubs. Yet the result, says Mike Grenier, a house master at Eton, may be to demotivate a child and even cause psychological damage. Such “hyper parenting is at its most extreme in London, where a rise in the birth-rate has heightened competition for places at private pre prep schools.

Mr Grenier say: “We know that for a lot of pre schools in some of the more affluent areas- Knightsbridge, Kensington, Battersea- the perception is that there are not enough places and that is it is only in a private school that you are going to get the quality starting from the age of 3 or 4 that will see you pass to the next stage through the private sector. So the reality is that there are children who are being given interview coaching at the age of 3 or 4”. He has heard worse from New York: children doing an hour or more music practice or tutoring before school, two or three hours of one to one tuition afterwards then a physically demanding activity such as swimming or ballet.

Ironically, Mr Grenier says, such parents may be holding their children back by not allowing them to take risks, make mistakes and learn from them. “Not only are they in danger of demotivating children because they feel they are a passive project being constructed rather against their will but it could lead people to feel very anxious when confronted by new difficulties.”

Moreover, he says, parents ought to be role models for their children, and living with pressure and anxiety is not a good example. Mr Grenier is an advocate of how slow education, a concept adapted from a culinary movement begun in Italy as an antidote to fast food.

With other teachers, in private and state schools, he is spearheading a campaign to infuse this approach into education, and will speak at the London Festival of Education next month. But isn’t Eaton itself a hothouse? There is a tremendous amount of pressure, he concedes: working hard is the norm here. “Peer group pressure is important and in some ways is a tremendously positive and motivating force. The boys want to do well, they want to keep up and boys are competitive.”

He identifies three spheres for learning at Eaton. First is the curriculum, in which, slow, schooling means more independent research, project work, collaboration, reflection. Second come its many extracurricular activities: the housemaster’s sitting room looks out on playing fields where Eaton’s first XV rugby team is practicing drills in the rain. Third area is activity lead by the boys themselves. “The experience there is so successful, in particular with teenagers because so much of it is self-motivated.” He says. “Boys are choosing to direct their own plays, to enter creative pries, volunteer for mentoring programmes.”

The role of a teacher or parent, he says, is to provide a safety net as a child walks a tightrope, and to raise or lower it. “The danger of hyper- parenting,”Mr Grenier says, “Is that it is intrusive and they don’t even let them get on the high rope at all.”

 

Gerry Gajadharsingh writes:

It’s great to see top schools like Eaton realising that over stimulation of children is often not helpful in their overall development. We seem in such a rush to pack so many things into our children’s lives that we often fail to understand that “less is sometimes more”. Giving time and space i.e. “slowing down” allows certain parts of the brain to develop properly and minimises the risk of turning our children into “stressed” individuals, which may come back to haunt them in adult life. Don’t forget that 95% of our brain activity is subconscious and it’s our subconscious brain that allows our bodies to run smoothly in the background without having to think too much about it. Time and space allows ideas to happen and helps with our creativity.

 

 

London

4th Floor North, 25 Wimpole Street,
London W1G 8GL

+44 (0)20 7631 1414

Buckinghamshire

Bowers Cottage, Magpie Lane, Coleshill,
Amersham, Buckinghamshire HP7 0LU

+44 (0)1494 431 293

Appointments

Request an Appointment