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Published on Leave a comment on Even Six Days of Corticosteroid Use Is Linked to Higher Rate of Problems

Image result for pills wikipedia Huh?...A recent study found that short-term use (less than 30 days) of commonly prescribed corticosteroid medications are linked to some nasty side-effects: an increase in rates of sepsis,  venous thromboembolism, and fractures. The most common reasons for the prescriptions were for upper respiratory tract infections, spinal conditions, bronchitis, and allergies. The study looked at 1.5 milliion patients, and found that the most common prescriptions written for oral corticosteroids was a six day methylprednisolone “dosepak” (about 47% of prescriptions). Note that while this was an "observational" study (so doesn't prove corticosteroid medication caused the effects), it still is concerning. One should always keep in mind that all medications have side effects, some bigger and some smaller.

Corticosteroids are powerful anti-inflammatory drugs that have been used to treat a variety of diseases for over seven decades. Long term use of corticosteroids is generally avoided because of the risks of serious complications (such as infection, venous thromboembolism, fractures, as well as chronic diseases). However, side-effects of short-term use have been unclear- which is why they are so frequently prescribed (about 1 in 5 Americans or 21% of the people in this study). This is why this study was needed. From Medical Xpress:

Common drugs, uncommon risks? Higher rate of serious problems after short-term steroid use

Millions of times a year, Americans get prescriptions for a week's worth of steroid pills, hoping to ease a backache or quell a nagging cough or allergy symptoms. But a new study suggests that they and their doctors might want to pay a bit more attention to the potential side effects of this medication. People taking the pills were more likely to break a bone, have a potentially dangerous blood clot or suffer a life-threatening bout of sepsis in the months after their treatment, compared with similar adults who didn't use corticosteroids, researchers from the University of Michigan report in a new paper in the British Medical Journal (BMJ).

Though only a small percentage of both groups went to the hospital for these serious health threats, the higher rates seen among people who took steroids for even a few days are cause for caution and even concern, the researchers say. The study used data from 1.5 million non-elderly American adults with private insurance. One in 5 of them filled a short-term prescription for oral corticosteroids such as prednisone sometime in the three-year study period. While the rates of the serious events were highest in the first 30 days after a prescription, they stayed elevated even three months later.

Using anonymous insurance claims data that IHPI purchased for use by U-M health care researchers, they found that half of the people who received oral steroids had gotten them for just six diagnoses, related to back pain, allergies or respiratory tract infections including bronchitis. Nearly half received a six-day prepackaged methylprednisolone "dosepak," which tapers the dose of steroids from highest to lowest. 

Dr. Waljee and his colleagues found higher rates of sepsis, venous thromboembolism (VTE) and fractures among short-term steroid users using multiple different statistical approaches to ensure their findings were as robust as possible....The consistent findings across the three approaches are important given the frequent use of these drugs and potential implications for patients. Waljee notes that the reason for this broad effect of steroids on complications may have its roots in how the drugs work: they mimic hormones produced by the body, to reduce inflammation but this can also induce changes that put patients at additional risk of serious events.

In the meantime, based on the new results, he advises patients and prescribers to use the smallest amount of corticosteroids possible based on the condition being treated. "If there are alternatives to steroids, we should be use those when possible," he says. "Steroids may work faster, but they aren't as risk-free as you might think." [Original study.]

Published on Leave a comment on Eating Fresh Fruit Is Linked to Lower Risk of Diabetes and Diabetic Complications

 Good news! Once again a study has confirmed that eating fresh fruits is associated with a lower incidence of type 2 diabetes. And even better - there is a dose related relationship - the more one eats daily, the better. So don't worry about the "sugar content" of fruit - the key is to eat fruit (as well as vegetables) to lower the risk of getting diabetes. And if you have type 2 diabetes, it will lower the incidence of death and complications from diabetes.

Here are the numbers for the 7 year study done in China of almost half a million people: eating fresh fruit was associated with a 12% lower risk of developing diabetes (compared to those never or rarely consuming fresh fruit). And in those who already had diabetes at the start of the study, consuming fresh fruit more than three days a week was associated with a 17% lower relative risk of dying from any cause and a 13%–28% lower risk of developing diabetes-related complications than those who consumed fruit less than one day per week.

Yes, I remember the advice that used to be given and is still given in parts of the world - that if you have diabetes, to restrict fruit, but studies are showing that advice to be wrong. Note that eating fresh fruits and vegetables has lots of other health benefits also - including lower rates of heart disease, stroke, and better mental (cognitive) functioning. From Science Daily:

Fresh fruit consumption linked to lower risk of diabetes and diabetic complications

In a research article published in PLOS Medicine, Huaidong Du of the University of Oxford, Oxford, United Kingdom and colleagues report that greater consumption of fresh fruit was associated with a lower incidence of diabetes, as well as reduced occurrence of complications in people with diabetes, in a Chinese population.

Although the health benefits of diets including fresh fruit and vegetables are well established, the sugar content of fruit has led to uncertainty about associated risks of diabetes and of vascular complications of the disease. Du and colleagues studied nearly 500,000 people participating in the China Kadoorie Biobank over about 7 years of follow-up, documenting new cases of diabetes and recording the occurrence of vascular disease and death in people with pre-existing diabetes.

The researchers found that people who reported elevated consumption of fresh fruit had a lower associated risk of developing diabetes in comparison with other participants (adjusted hazard ratio [aHR] 0.88, 95% CI 0.83-0.93), which corresponds to an estimated 0.2% reduction in the absolute risk of diabetes over 5 years. In people with diabetes, higher consumption of fresh fruit was associated with a lower risk of mortality (aHR 0.83, 95% CI 0.74-0.93 per 100g fruit/d), corresponding to an absolute decrease in risk of 1.9% at 5 years, and with lower risks of microvascular and macrovascular complications. [Original study.]

Published on Leave a comment on Foods High In Potassium Linked to Lower Blood Pressure

Nothing new here, but good to have it discussed again: eating foods high in potassium and low in sodium (salt) lowers blood pressure. Why should we care? Hypertension (high blood pressure) is a global health issue. The World Health Organization estimates that hypertension is responsible for at least 51 percent of deaths due to stroke and 45 percent of deaths due to heart disease.

Eating the potassium rich foods seems to be key. Some foods high in potassium: bananas, baked potatoes, sweet potatoes, dark leafy greens (e.g., spinach, kale), tomatoes, mushrooms, beans (e.g., white beans, pinto beans), lentils, nuts, broccoli, apricots, milk. In other words, eat an assortment of fruits, vegetables, beans, and nuts to get potassium. And coincidentally these same foods are low in sodium (salt) - a win-win for heath. From Science Daily:

Fruits and vegetables' latest superpower? Lowering blood pressure

Eating potassium-rich foods like sweet potatoes, avocados, spinach, beans, bananas -- and even coffee -- could be key to lowering blood pressure, according to Alicia McDonough, PhD, professor of cell and neurobiology at the Keck School of Medicine of the University of Southern California (USC). "Decreasing sodium intake is a well-established way to lower blood pressure," McDonough says, "but evidence suggests that increasing dietary potassium may have an equally important effect on hypertension."

McDonough explored the link between blood pressure and dietary sodium, potassium and the sodium-potassium ratio in a review article....McDonough's review found several population studies demonstrating that higher dietary potassium (estimated from urinary excretion or dietary recall) was associated with lower blood pressure, regardless of sodium intake. Interventional studies with potassium supplementation also suggested that potassium provides a direct benefit.

McDonough reviewed recent studies in rodent models, from her own lab and others, to illustrate the mechanisms for potassium benefit. These studies indicated that the body does a balancing act that uses sodium to maintain close control of potassium levels in the blood, which is critical to normal heart, nerve and muscle function. "When dietary potassium is high, kidneys excrete more salt and water, which increases potassium excretion," McDonough says. "Eating a high potassium diet is like taking a diuretic." "If you eat a typical Western diet," McDonough says, "your sodium intake is high and your potassium intake is low. This significantly increases your chances of developing high blood pressure." 

But how much dietary potassium should we consume? A 2004 Institute of Medicine report recommends that adults consume at least 4.7 grams of potassium per day to lower blood pressure, blunt the effects of dietary sodium and reduce the risks of kidney stones and bone loss, McDonough says. Eating ¾ cup of black beans, for example, will help you achieve almost 50 percent of your daily potassium goal. [Original study.]

Published on Leave a comment on High Dose Vitamin D Does Not Prevent Cardiovascular Disease

A recent study looking at high dose supplementation of vitamin D found that it did not prevent cardiovascular disease. This study came about because of earlier studies observing that there is a higher incidence of cardiovascular disease in persons with low vitamin D levels (as measured in their blood). But such results from observational studies need rigorous testing in studies where people are randomly assigned to groups, and that are "double-blind" (no one knows who is getting the vitamin D until the end of the study) to eliminate bias. And this is what was done in this study, with the result that monthly high doses of vitamin D3 for 3 years did not prevent cardiovascular disease (including stroke, heart attacks, hypertension, etc) - as seen in that there were no group differences between the vitamin D and placebo groups. Finding no effects are "null findings".

But note that the subjects in the study got monthly high doses, and not daily or weekly vitamin D. It is unknown whether daily dosing would have made a difference in the results. However, the vitamin D levels in the blood soon reached levels (about 51.725 ng/mL) that many view as a desirable "protective" level. So we'll see what other studies find. But these results are definitely disappointing for those wanting an easy "magic bullet" for preventing cardiovascular disease. Bottom line: focus on lifestyle (diet, exercise, not smoking, etc) for heart health. From Science Daily:

Monthly high-dose vitamin D supplementation does not prevent cardiovascular disease

Results of a large randomized trial indicate that monthly high-dose vitamin D supplementation does not prevent cardiovascular disease, according to a study published by JAMA Cardiology. Studies have reported increased incidence of cardiovascular disease (CVD) among individuals with low vitamin D status. To date, randomized clinical trials of vitamin D supplementation have not found an effect, possibly because of using too low a dose of vitamin D. Robert Scragg, M.B.B.S., Ph.D., of the University of Auckland, New Zealand, and colleagues randomly assigned adults (age 50 to 84 years) to receive oral vitamin D3 (n = 2,558; an initial dose of 200,000 IU, followed a month later by monthly doses of 100,000 IU) or placebo (n = 2,552) for a median of 3.3 years.

Of the 5,108 participants included in the primary analysis, the average age was 66 years; 25 percent were vitamin D deficient. Cardiovascular disease occurred in 303 participants (11.8 percent) in the vitamin D group and 293 participants (11.5 percent) in the placebo group. Similar results were seen for participants with vitamin D deficiency at study entry and for other outcomes such as heart attack, angina, heart failure, hypertension, and stroke.

The authors write that the results of this study do not support the use of monthly high-dose vitamin D for the prevention of CVD. "The effects of daily or weekly dosing on CVD risk require further study." [Original study.]

Published on Leave a comment on Gut Microbes of Babies Exposed to Pets

More research supports that being exposed to pets during pregnancy or in the first months of life changes the gut bacteria, and in a way that is thought to be beneficial. The researchers found that infants exposed to pets prenatally or after birth (or both) had higher levels of two microbes that are associated with a lower risk of allergies and obesity. The two microbes are Ruminococcus and Oscillospira, but in case you're wondering - they are not (yet) available in probiotics.

And these differences in gut bacteria occurred no matter how the infants were born or fed (C-section, vaginal, breastfed, formula fed), or whether they received antibiotics at birth or not  - it was the pet exposure that was most important. The evidence is building that if one wants to avoid allergies in children - to have them exposed to furry pets in the first  year of life, and according to this study - perhaps before birth also. From Science Daily:

Pet exposure may reduce allergy and obesity

A new University of Alberta study showed that babies from families with pets -- 70 per cent of which were dogs -- showed higher levels of two types of microbes associated with lower risks of allergic disease and obesity.

"There's definitely a critical window of time when gut immunity and microbes co-develop, and when disruptions to the process result in changes to gut immunity," said Anita Kozyrskyj, a U of A pediatric epidemiologist....The latest findings from Kozyrskyj and her team's work on fecal samples collected from infants registered in the Canadian Healthy Infant Longitudinal Development study build on two decades of research that show children who grow up with dogs have lower rates of asthma. 

Her team of 12, including study co-author and U of A post-doctoral fellow Hein Min Tun, take the science one step closer to understanding the connection by identifying that exposure to pets in the womb or up to three months after birth increases the abundance of two bacteria, Ruminococcus and Oscillospira, which have been linked with reduced childhood allergies and obesity, respectively.

"The abundance of these two bacteria were increased twofold when there was a pet in the house," said Kozyrskyj, adding that the pet exposure was shown to affect the gut microbiome indirectly -- from dog to mother to unborn baby -- during pregnancy as well as during the first three months of the baby's life. In other words, even if the dog had been given away for adoption just before the woman gave birth, the healthy microbiome exchange could still take place.

The study also showed that the immunity-boosting exchange occurred even in three birth scenarios known for reducing immunity, as shown in Kozyrskyj's previous work: C-section versus vaginal delivery, antibiotics during birth and lack of breastfeeding. What's more, Kozyrskyj's study suggested that the presence of pets in the house reduced the likelihood of the transmission of vaginal GBS (group B Strep) during birth, which causes pneumonia in newborns and is prevented by giving mothers antibiotics during delivery. [Original study.]

Published on Leave a comment on Eat Lots of Fiber For Gut Health

 Nice research that basically says: food is medicine. In other words, eat lots of whole grains and legumes (beans) for gut health - to feed the beneficial microbes in your gut and prevent (hopefully) colon cancer. While the clinical trial studied colorectal cancer survivors and the effects of 4 weeks of adding rice bran or navy beans or placebo (nothing extra) daily to their diet - the positive effects of adding the extra dietary fiber included increased microbiome richness and diversity in the rice bran group (which is good).

And when researchers treated colorectal cancer cells with stool extracts from these groups, they saw reduced cell growth from the groups that had increased rice bran and navy bean consumption. This was an important finding and stresses that adding fiber to the diet is beneficial to gut health, and perhaps may prevent colorectal cancer.

Other studies have also found a diet with lots of legumes (beans), whole grains, vegetables, fruits, nuts, and seeds to be beneficial for gut microbes and gut health. A classic study (from 2015) found dramatic changes in the colon (specifically in the colonic mucosa) from dietary changes in as little as 2 weeks. They compared the typical low-fat, high fiber diet of South Africa with an “American” high-fat, low-fiber diet, and found that after two weeks on the high fiber African diet, there was significantly less inflammation in the colon and reduced biomarkers of cancer risk. On the other hand, measurements indicating cancer risk dramatically increased after two weeks on the western diet. That study found that a major reason for the changes in cancer risk was the way in which the bacteria in the gut (the microbiome) were altered in adapting to the new diet. The researchers suggested trying for at least 50 grams of fiber per day for gut health benefits.

From Medical Xpress: Phase II trial: Rice bran adds microbiome diversity, slows growth of colon cancer cells

Today at the American Association for Cancer Research (AACR) Annual Meeting 2017, University of Colorado Cancer Center researchers at Colorado State University present results of a phase II clinical trial of 29 people exploring the effects of adding rice bran or navy beans to the diets of colorectal cancer survivors. After the 4-week randomized-controlled trial during which people added rice bran, navy bean powder or neither, both the rice bran and navy bean groups showed increased dietary fiber, iron, zinc, thiamin, niacin, vitamin B6, folate, and alpha-tocopherol. The rice bran group also showed increased microbiome richness and diversity. When researchers treated colorectal cancer cells with stool extracts from these groups, they saw reduced cell growth from the groups that had increased rice bran and navy bean consumption.

Previous work shows the ability of these diets to decrease colorectal cancer risk in animal models. The current trial confirms that people can eat enough bean- and rice bran-enhanced foods to promote gut health at levels shown to prevent colorectal cancer in animals. Guidelines from the American Institute for Cancer Research recommend reducing the risk of cancer by eating more vegetables, fruits, whole grains and legumes, such as beans. Ryan has established from these studies that eating a half-cup of beans and 30 grams of rice bran per day is enough to see changes in small molecules that can confer protection against colorectal cancer.

"The simple message is, 'Food is medicine,' and we are looking at how to simplify that and make it apply to our everyday lives," says study co-author Regina Brown, MD, assistant professor at the CU School of Medicine and oncologist for CUHealth...."The evidence is there in animals and we can now study this in people. The question is, what are we doing to achieve adequate levels of intake of these foods?" Ryan said. "It's not enough to say 'I eat them once in a while.' That's not going to work, particularly if you are at higher risk. You have to meet a dose, just like you need a dose of a certain drug, you need to reach intake levels and consume increased amounts of these foods, and that's where people, including me, are challenged. Not everyone wants to open up a can of beans and eat them every day."

Published on Leave a comment on Getting A Second Opinion Might Be A Good Idea

Image result for stethoscope A new Mayo Clinic study reinforces that YES - a person  should get a second opinion when dealing with a complex medical condition. The study compared the referring diagnosis to the final diagnosis of 286 patients referred to the Mayo Clinic by physician assistants, nurse practitioners, and physicians. The researchers found that in only 12 percent of the cases was the diagnosis confirmed. In 21 percent of the cases, the diagnosis was completely changed, while 66 percent of patients received a refined or redefined diagnosis. There were no significant differences between the referring diagnoses made by physician assistants, nurse practitioners, and physicians.

But one concern I have with the study is - how do we know that the Mayo Clinic diagnosis was the correct one, especially in the 21% of cases they gave a completely different diagnosis (what they called "misdiagnosis")? Hmm..? Bottom line: Yes, a second opinion adds to the medical costs, but it may be helpful. From Science Daily:

The value of second opinions demonstrated in study

Many patients come to Mayo Clinic for a second opinion or diagnosis confirmation before treatment for a complex condition. In a new study, Mayo Clinic reports that as many as 88 percent of those patients go home with a new or refined diagnosis -- changing their care plan and potentially their lives. Conversely, only 12 percent receive confirmation that the original diagnosis was complete and correct.

Often, because of the unusual nature of the symptoms or complexity of the condition, the physician will recommend a second opinion. Other times, the patient will ask for one.....To determine the extent of diagnostic error, the researchers examined the records of 286 patients referred from primary care providers to Mayo Clinic's General Internal Medicine Division in Rochester over a two-year period (Jan. 1, 2009, to Dec. 31, 2010). This group of referrals was previously studied for a related topic. It consisted of all patients referred by nurse practitioners and physician assistants, along with an equal number of randomly selected physician referrals.

The team compared the referring diagnosis to the final diagnosis to determine the level of consistency between the two and, thus, the level of diagnostic error. In only 12 percent of the cases was the diagnosis confirmed. In 21 percent of the cases, the diagnosis was completely changed; and 66 percent of patients received a refined or redefined diagnosis. There were no significant differences between provider types.

Published on Leave a comment on Marathon Running Linked To Short Term Kidney Injury

A possible problem with running marathons is short term kidney injury in the two days right after the race. A study of 22 runners in the 2015 Hartford (Connecticut) Marathon found that most of the runners temporarily developed acute kidney injury (AKI) directly after the race. The study main author Chirag R. Parikh, MD, PhD said: "The kidney responds to the physical stress of marathon running as if it's injured, in a way that's similar to what happens in hospitalized patients when the kidney is affected by medical and surgical complications".

The runners studied fully recovered from the kidney injury 2 days after the event, but the study raises questions about the long-term effects for regular marathon runners, especially in warmer climates. Also, how about the effects of repeated marathons? The researchers say they can only speculate that marathoners adapt to the kidney injury, because they recover within 2 days. But they also pointed out that research has shown there are also changes in heart function associated with marathon running. Something else to keep in mind when considering training for marathons. From Science Daily:

Marathon running may cause short-term kidney injury

According to a new Yale-led study, the physical stress of running a marathon can cause short-term kidney injury. Although kidneys of the examined runners fully recovered within two days post-marathon, the study raises questions concerning potential long-term impacts of this strenuous activity at a time when marathons are increasing in popularity. More than a half million people participated in marathons in the United States in 2015.

While past research has shown that engaging in unusually vigorous activities -- such as mine work, harvesting sugarcane, and military training -- in warm climates can damage the kidneys, little is known about the effects of marathon running on kidney health. A team of researchers led by Professor of Medicine Chirag Parikh, M.D. studied a small group of participants in the 2015 Hartford Marathon. The team collected blood and urine samples before and after the 26.2-mile event. They analyzed a variety of markers of kidney injury, including serum creatinine levels, kidney cells on microscopy, and proteins in urine.

The researchers found that 82% of the runners that were studied showed Stage 1 Acute Kidney Injury (AKI) soon after the race. AKI is a condition in which the kidneys fail to filter waste from the blood. "The kidney responds to the physical stress of marathon running as if it's injured, in a way that's similar to what happens in hospitalized patients when the kidney is affected by medical and surgical complications," said Parikh. The researchers stated that potential causes of the marathon-related kidney damage could be the sustained rise in core body temperature, dehydration, or decreased blood flow to the kidneys that occur during a marathon. [Original study.]

Published on Leave a comment on Does Vitamin D Prevent Cancer?

Does vitamin D prevent cancer? There has been much debate over whether increasing levels of vitamin D (as measured in a person's blood) results in a lower incidence of cancer. Studies find a number of health problems linked to low levels of vitamin D (here, here, here), while studies looking at vitamin D and cancer have been "inconsistent" in their results. Some say yes - vitamin D is protective, while some say there is no effect from vitamin D supplements. Now a 4 year study (yes, yes - it's a very short length of time in which to study the onset of cancer) found no difference in the rate of cancer among two groups of postmenopausal women who received either: 2,000 IU per day of vitamin D3 and 1,500 mg per day of calcium OR an identical looking placebo. They looked for any kind of cancer occurring.

The Creighton University researchers found a difference among the women after 4 years, with the vitamin D plus calcium supplement group having fewer cancers (and a lower percentage of cancer) as compared to the placebo group, but...it did not reach statistical significance. So you could say it was due to chance. But when the researchers looked at the number of cancers from year 2 to 4, then the difference was statistically significant - that vitamin D was protective. The researchers wonder if the cancers diagnosed in year 1 were already developing before the study started. Note: The 2,000 IU per day vitamin D3 supplements in this study are considered high doses - "high dose supplementation".

The researchers point out that the women who were given vitamin D3 and calcium supplements had a 30% lower risk of cancer, even though this difference in cancer incidence rates between the 2 groups did not quite reach statistical significance. But both groups started with a fairly high vitamin D level -  an average 25-hydroxyvitamin D (25[OH]D) levels of 32.8 ng/m (which is above the average US population level). And in the supplement group it was raised to 43.9 ng/mL. Note that some researchers view vitamin D levels of 33 ng/mL  (the baseline level in both groups) as already protective against cancer.

Also, even during the study the placebo group was allowed to take their own vitamin D and calcium supplements as long as it wasn't more than the recommended amounts (800 IU per day for vitamin D and 1500 mg per day for calcium) - which makes those individuals actually a low vitamin D supplementation group rather than no supplementation, which might hide any treatment effects and so make the results for the 2 groups look similar. What is needed is a much longer follow-up, larger groups of women, and both high and low dose vitamin D supplement groups. Some studies suggest that whether a low or high dose taken has an effect on cancer incidence.

I still think this study period was way too short - to me, 5 or more years would have been more convincing, and the groups too small. Also, it was unfortunate that they were also given calcium supplements or that there wasn't a just vitamin D group. Combining vitamin D with calcium supplements just muddies the results (in my opinion), and also because calcium supplements are linked to health problems such as cardiovascular disease. So in this study can't tell what the separate effects of calcium and vitamin D are. (Note that calcium rich foods, however, are beneficial to health.)

But a big positive of the study was that the women were randomly assigned to either the vitamin D plus calcium group or the placebo group, and no one - not the women or their doctors knew who got what until the end of the study (to eliminate bias it was "double-blind"). Note The supplements used were vitamin D3 and not D2. Vitamin D can also be easily obtained by exposure to sunlight in the summer months.

Excerpts from Creighton University release about the study in Science Daily: Does Vitamin D decrease risk of cancer?

The study, funded by the National Institutes of Health, is a randomized clinical trial of the effects of vitamin D supplementation on all types of cancer combined. The four-year study included 2,303 healthy postmenopausal women 55 years and older from 31 counties in Nebraska. Participants were randomly assigned to take either 2000 international units (IU) of vitamin D3 and 1500 mg. of calcium or identical placebos daily for 4 years. The vitamin D3 dose was about three times the US government's Recommended Dietary Allowance (RDA) of 600 IU for adults through age 70, and 800 IU for those 71 and older. Women who were given vitamin D3 and calcium supplements had 30% lower risk of cancer. This difference in cancer incidence rates between groups did not quite reach statistical significance. However, in further analyses, blood levels of vitamin D, specifically 25-hydroxyvitamin D (25(OH)D), were significantly lower in women who developed cancer during the study than in those who remained healthy.

Original study in JAMA: Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women. Accompanying editorial about the study in JAMA:  Vitamin D, Calcium, and Cancer: Approaching Daylight?

Published on Leave a comment on Many Heart Disease, Stroke, and Type 2 Diabetes Deaths Linked to Diet

Is this really a surprise to anyone at this point? According to a recent study: Almost half of all deaths in the United States in 2012 that were caused by cardiometabolic diseases such as heart disease, stroke and type 2 diabetes, have been linked to "suboptimal diets" - that is, to eating poorly and so not getting enough of certain foods and nutrients, and too much of other foods. Deaths due to heart disease, stroke, or type 2 diabete were linked to: high sodium (salt) intake, not eating enough nuts and seeds, a high intake of processed meats, and low intake of seafood omega-3 fats.

The study looked at consumption of 10 foods or nutrients that are associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium. The researchers incorporated data from National Health and Nutrition Examination Surveys, from studies and clinical trials, and from the National Center for Health Statistics. So how should one eat for heath? Lots of fruits and vegetables, legumes (beans), nuts, seeds, whole grains, fish, and less processed food and fast food. (A plus of this is that it also feeds your beneficial gut microbes.) Read ingredient lists and try to avoid whatever foods have ingredients that you ordinarily wouldn't cook with or don't understand what they are (for example, colors, additives, titanium dioxide, artificial or natural flavors, etc.). From Science Daily:

High number of deaths from heart disease, stroke and diabetes linked to diet

Nearly half of all deaths in the United States in 2012 that were caused by cardiometabolic diseases, including heart disease, stroke and type 2 diabetes, have been linked to substandard eating habits, according to a study published in the March 7 issue of JAMA and funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. Of the 702,308 adult deaths due to cardiometabolic diseases, 318,656, or about 45 percent, were associated with inadequate consumption of certain foods and nutrients widely considered vital for healthy living, and overconsumption of other foods that are not.

The list includes foods and nutrients long-associated with influencing cardiometabolic health. The highest percentage of deaths was linked to excess consumption of sodium. Processed meats, sugar-sweetened beverages and unprocessed red meats were also consumed in excess. Americans did not consume enough of some foods that have healthful effects such as fruits, vegetables, nuts and seeds, whole grains, polyunsaturated fats and seafood omega-3 fats.

The study also shows that the proportion of deaths associated with diet varied across population groups. For instance, death rates were higher among men when compared to women; among blacks and Hispanics compared to whites; and among those with lower education levels, compared with their higher-educated counterparts. The authors concluded that "these results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health." The study findings were based on death certificate data collected by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.