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People have asked me if it is healthy to exercise or ride a bicycle in the congested and polluted New York metro area. According to this much quoted in the past week study from the University of Copenhagen - it is better to exercise than not in polluted cities when looking at death rates. But is their air pollution even comparable to ours? What does it do to our lungs to bicycle daily behind smoke belching buses?

Even the researcher said:"It is also important to note that these results pertain to Denmark and sites with similar air pollution levels, and may not necessary be true in cities with several fold higher air pollution levels, as seen in other parts of the world." They also stated: "...we would still advise people to exercise and cycle in green areas, parks, woods, with low air pollution and away from busy roads, when possible." From Science Daily:

Exercise can outweigh harmful effects of air pollution

The beneficial effects of exercise are more important for our health than the negative effects of air pollution, in relation to the risk of premature mortality, new research shows. In other words, benefits of exercise outweigh the harmful effects of air pollution.The study shows that despite the adverse effects of air pollution on health, air pollution should be not perceived as a barrier to exercise in urban areas. "Even for those living in the most polluted areas of Copenhagen, it is healthier to go for a run, a walk or to cycle to work than it is to stay inactive," says Associate Professor Zorana Jovanovic Andersen from the Centre for Epidemiology and Screening at the University of Copenhagen.

It is well known that physical activity reduces, while air pollution increases the risk of premature mortality. Physical activity amplifies respiratory intake and accumulation of air pollutants in our lungs, which may increase the harmful effects of air pollution during exercise."However, we would still advise people to exercise and cycle in green areas, parks, woods, with low air pollution and away from busy roads, when possible," she adds.

The Danish study includes 52,061 subjects, aged 50-65 years, from the two main cities Aarhus and Copenhagen, who participated in the cohort study Diet, Cancer and Health..,5,500 participants died before 2010, and the researchers observed about 20% fewer deaths among those who exercised than among those who didn't exercise, even for those who lived in the most polluted areas, in central Copenhagen and Aarhus, or close to busy roads and highways.

"It is also important to note that these results pertain to Denmark and sites with similar air pollution levels, and may not necessary be true in cities with several fold higher air pollution levels, as seen in other parts of the world," concludes Andersen.

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After reading this article, I looked over my last year's posts and realized that the recent studies posted all found that eating fish showed health benefits (and they did not look at supplements). Once again, a food shows benefits while the supplement is debatable. Current advice: try to eat fish at least twice a week. From the NY Times:

Fish Oil Claims Not Supported by Research

Fish oil is now the third most widely used dietary supplement in the United States, after vitamins and minerals, according to a recent report from the National Institutes of Health. At least 10 percent of Americans take fish oil regularly, most believing that the omega-3 fatty acids in the supplements will protect their cardiovascular health. But there is one big problem: The vast majority of clinical trials involving fish oil have found no evidence that it lowers the risk of heart attack and stroke.

From 2005 to 2012, at least two dozen rigorous studies of fish oil were published in leading medical journals, most of which looked at whether fish oil could prevent cardiovascular events in high-risk populations. These were people who had a history of heart disease or strong risk factors for it, like high cholesterol, hypertension or Type 2 diabetes. All but two of these studies found that compared with a placebo, fish oil showed no benefit.

In theory at least, there are good reasons that fish oil should improve cardiovascular health. Most fish oil supplements are rich in two omega-3 fatty acids — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — that can have a blood-thinning effect, much like aspirin, that may reduce the likelihood of clots. Omega-3s can also reduce inflammation, which plays a role in atherosclerosis. And the Food and Drug Administration has approved at least three prescription types of fish oil — Vascepa, Lovaza and a generic form — for the treatment of very high triglycerides, a risk factor for heart disease. But these properties of omega-3 fatty acids have not translated into notable benefits in most large clinical trials.

Like many cardiologists, Dr. Stein encourages his patients to avoid fish oil supplements and focus instead on eating fatty fish at least twice a week, in line with federal guidelines on safe fish intake, because fish contains a variety of healthful nutrients other than just EPA and DHA. “We don’t recommend fish oil unless someone gets absolutely no fish in their diets,” Dr. Stein said.

But some experts say the case for fish oil remains open. Dr. JoAnn Manson, the chief of preventive medicine at Brigham and Women’s Hospital in Boston, said the large clinical trials of fish oil focused only on people who already had heart disease or were at very high risk. Fish oil has also been promoted for the prevention of a variety of other conditions, including cancer, Alzheimer’s and depression. Dr. Manson is leading a five-year clinical trial, called the Vital study, of 26,000 people who are more representative of the general population. Set to be completed next year, it will determine whether fish oil and vitamin D, separately or combined, have any effect on the long-term prevention of heart disease, Type 2 diabetes, and other diseases in people who do not have many strong risk factors.

Dr. Manson says that although she recommends eating fatty fish first, she usually does not stop people from taking fish oil, in part because it does not seem to have major side effects in generally healthy people. “But I do think people should realize that the jury is still out,” she said, “and that they may be spending a lot of money on these supplements without getting any benefit.”

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It is important to identify protective factors as well as risk factors for cataracts because cataract surgery is the only treatment for cataracts. Cataracts are a medical condition resulting in clouding of the normally clear lens of the eye, which results in blurred vision.

From Medscape: Physical Activity May Reduce Cataract Risk

High levels of total and long-term physical activity, as well as specific types of physical activity, may decrease the risk for age-related cataract later in life, researchers report in an article published in the February issue of Ophthalmology. Of 52,660 men and women 45 to 83 years of age who completed questionnaires to assess physical activity as part of two large population-based cohorts, 11,580 developed age-related cataract during a 12-year follow-up period...

Participants with the highest quartile of physical activity had a 13% decreased risk of developing cataracts relative to those with the lowest levels of physical activity, after adjustments for multiple factors including fruit and vegetable intake, antioxidant supplement use, and alcohol intake ...In addition, increased amounts of long-term total physical activity both at 30 years of age and at the beginning of the study (mean age, 59.4 years) decreased the risk for cataract by 24% compared with low levels of activity, according to the researchers .

When the investigators looked at specific activities, they found that walking or bicycling 60 minutes per day or more decreased the risk for cataract by 12% compared with hardly ever walking or bicycling, and work or occupational activity requiring heavy manual labor decreased the risk for cataract by 16% compared with mostly sedentary occupations. Compared with individuals reporting less than 1 hour of leisure time inactivity per day, those who were physically inactive for 6 or more hours of leisure time daily were 27% more likely to develop age-related cataract, they write.

"Our results on different types of physical activity suggest that being physically active on a regular daily basis may contribute to decreased risk of cataract, rather than short weekly episodes of exercising/training," Selin explained in an interview with Medscape Medical News.

Keep in mind that statin use is linked to increased risk of cataracts. From Science Daily:

New study strengthens evidence of connection between statin use and cataracts; any risks should be weighed against benefits

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There are a number of very good health reasons to cut back or totally eliminate soda from your diet. The following articles and earlier posts discuss some of the ways both diet and regular soda are linked to health problems. Note in the second article that there's currently no federal limit for a byproduct of some types of caramel color called 4-MEI (a carcinogen) in food or beverages. California's Proposition 65 Law (aimed at reducing consumers' exposure to toxic chemicals) requires a  health-warning label on sodas with too high levels of 4-MEI resulted in manufacturers producing soda with lower levels of that chemical in the state. But sodas out of California may have higher levels! From Science Daily:

Diet soda linked to increases in belly fat in older adults

Increasing diet soda intake is directly linked to greater abdominal obesity in adults 65 years of age and older. Findings raise concerns about the safety of chronic diet soda consumption, which may increase belly fat and contribute to greater risk of metabolic syndrome and cardiovascular diseases. Metabolic syndrome--a combination of risk factors that may lead to high blood pressure, diabetes, heart disease, and stroke--is one of the results of the obesity epidemic.

The San Antonio Longitudinal Study of Aging (SALSA) enrolled 749 Mexican- and European-Americans who were aged 65 and older at the start of the study (1992-96). Diet soda intake, waist circumference, height, and weight were measured at study onset, and at three follow-ups in 2000-01, 2001-03, and 2003-04, for a total of 9.4 follow-up years. At the first follow-up there were 474 (79.1%) surviving participants; there were 413 (73.4%) at the second follow-up and 375 (71.0%) at the third follow-up.

Findings indicate that the increase in waist circumference among diet soda drinkers, per follow-up interval, was almost triple that among non-users: 2.11 cm versus 0.77 cm, respectively. After adjustment for multiple potential confounders, interval waist circumference increases were 0.77 cm for non-users, 1.76 cm for occasional users, and 3.04 cm for daily users. This translates to waist circumference increases of 0.80 inches for non-users, 1.83 inches for occasional users, and 3.16 inches for daily users over the total 9.4-year SALSA follow-up period.

From Medical Xpress:

Popular soda ingredient poses cancer risk to consumers, new study suggests

Public health researchers have analyzed soda consumption data in order to characterize people's exposure to a potentially carcinogenic byproduct of some types of caramel color. Caramel color is a common ingredient in colas and other dark soft drinks. The results show that between 44 and 58 percent of people over the age of six typically have at least one can of soda per day, possibly more, potentially exposing them to 4-methylimidazole (4-MEI), a possible human carcinogen formed during the manufacture of some kinds of caramel color.

"Soft drink consumers are being exposed to an avoidable and unnecessary cancer risk from an ingredient that is being added to these beverages simply for aesthetic purposes," says Keeve Nachman, PhD, senior author of the study and director of the Food Production and Public Health Program at the CLF and an assistant professor at the Johns Hopkins Bloomberg School of Public Health. ."

In 2013 and early 2014, Consumer Reports partnered with the CLF to analyze 4-MEI concentrations of 110 soft drink samples purchased from retail stores in California and the New York metropolitan area...While the 2014 study of the 110 samples of soda brands was not large enough to recommend one brand over another or draw conclusions about specific brands, results indicated that levels of 4-MEI could vary substantially across samples, even for the same type of beverage. 

Researchers also found sharply contrasting levels of 4-MEI in some soft drinks purchased in the New York metropolitan area, versus California. "Our study also found that some of the soft drink products sold in California that we sampled had lower levels of 4-MEI than the samples we looked at of the same beverages sold outside the state, particularly in our earlier rounds of testing. It appears that regulations such as California's Proposition 65 may be effective at reducing exposure to 4-MEI from soft drinks, and that beverages can be manufactured in ways that produce less 4-MEI," suggests Nachman. ."

From Medical Daily: Bye-Bye Sugary Drinks: This Is What Happens To Your Body When You Stop Drinking Soda

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I was recently asked my thoughts about a nutritionist recommending Benecol spreads, which I actually had never heard of before. After researching Benecol, I looked with horror at all the non-real food ingredients in the various products (for example, Benecol light spread, with 39% vegetable oil, included partially hydrogenated soybean oil, plant stanol esters, various emulsifiers, potassium sorbate, artificial flavor, etc).  I was dismayed because to me it didn't seem like a "real food" - where were the "real" whole food ingredients? For example,consider emulsifiers which recent research says disrupts the "gut microbiome" (the community of microbes living in the gut) and causes inflammation. Which we all know is not good. And partially hydrogenated oils (trans fats) are again a big health no-no. And on and on.

And recently the Academy of Nutrition and Dietetics, an organization that represents some 75,000 registered dietitians and nutritionists, gave its first endorsement (with a "Kids Eat Right" seal of approval) to Kraft American cheese single slices. Huh? Processed cheese (with whey protein concentrate, emulsifiers, sodium citrate, etc.) got an approval seal and not real cheese? What is going on? The answer may lie with the fact that many nutritionists are accepting cash for endorsing certain foods, especially those promoted by big business companies. The latest to be endorsed are cans of Coca Cola soda! From the Tampa Bay Times:

 Coca-Cola paid nutritionists to tout Coke as heart healthy snack

If a column in honor of heart health suggests a can of Coke as a snack, you might want to read the fine print.The world's biggest beverage maker, which struggles with declining soda consumption in the U.S., is working with fitness and nutrition experts who suggest its cola as a healthy treat. In February, for instance, several wrote online pieces for American Heart Month, with each including a mini-can of Coke or small soda as a snack idea.

The mentions — which appeared on nutrition blogs and other sites including those of major newspapers — show the many ways food companies work behind the scenes to cast their products in a positive light, often with the help of third parties who are seen as trusted authorities.

Ben Sheidler, a Coca-Cola spokesman, compared the February posts to product placement deals a company might have with TV shows. "We have a network of dietitians we work with," said Sheidler, who declined to say how much the company pays experts. "Every big brand works with bloggers or has paid talent."

Other companies including Kellogg and General Mills have used strategies like providing continuing education classes for dietitians, funding studies that burnish the nutritional images of their products and offering newsletters for health experts. PepsiCo Inc. has also worked with dietitians who suggest its Frito-Lay and Tostito chips in local TV segments on healthy eating. Others use nutrition experts in sponsored content; the American Pistachio Growers has quoted a dietitian for the New England Patriots in a piece on healthy snacks and recipes and Nestle has quoted its own executive in a post about infant nutrition."

Most of the pieces suggesting mini-Cokes say in the bios that the author is a "consultant" for food companies, including Coca-Cola. Some add that the ideas expressed are their own. One column is marked at the bottom as a "sponsored article," which is an ad designed to look like a regular story. It ran on more than 1,000 sites, including those of major news outlets around the country. The other posts were not marked as sponsored content, but follow a similar format.

Kelly McBride, who teaches media ethics at The Poynter Institute, which owns the Tampa Bay Times, said the phrasing of the disclosure that the author is a "consultant" for food companies, including Coca-Cola, doesn't make it clear the author was specifically paid by Coke for the column."This is an example of opaque sponsored content," McBride said.

The Academy of Nutrition and Dietetics, a professional group for dietitians, says in its code of ethics that practitioners promote and endorse products "only in a manner that is not false and misleading." A spokesman for the academy did not respond when asked if the posts on mini-Cokes meet those guidelines. Meanwhile, a group called Dietitians for Professional Integrity has called for sharper lines to be drawn between dietitians and companies. Andy Bellatti, one of its founders, said companies court dietitians because they help validate corporate messages.

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Two studies that found a link with air pollution and health effects.The first found a narrowing of the carotid arteries (that bring blood to brain). This narrowing (stenosis) occurs prior to strokes. While this could be explained by other factors (for example, by especially poor diets or cigarette smoking), the link between high air pollution and heart attacks and strokes has been noted since the 1950s. From Medical Xpress:

Pollution levels linked to stroke-related narrowing of arteries

Air pollution has been linked to a dangerous narrowing of neck arteries that occurs prior to strokes, according to researchers at NYU Langone Medical Center. The scientists analyzed medical test records for more than 300,000 people living in New York, New Jersey or Connecticut. They found that people living in zip codes with the highest average levels of fine-particulate-matter pollution were significantly more likely to show signs of narrowing (stenosis) in their internal carotid arteries, compared to those living in zip codes with the lowest pollution levels.

Fine particulate matter pollutants, also called "PM 2.5 pollutants," are particulates with diameters less than 2.5 millionths of a meter. They are mostly by-products of combustion engines and burning wood. "We spend a lot of time thinking about traditional risk factors for stroke such as high blood pressure, cholesterol, diabetes and smoking—but our data underscore the possibility that everyday air pollution may also pose a significant stroke risk," said senior investigator Jeffrey S. Berger, MD, an assistant professor in NYU Langone Medical Center in the Department of Medicine, Leon H. Charney Division of Cardiology.

Medical researchers have noticed since the 1950s that episodes of high air pollution can bring temporary jumps in local heart attack and stroke cases. More recent studies have linked heart attack and stroke risks to long-term pollution exposures as well, including PM 2.5 exposures.

The two internal carotid arteries are situated on either side of the neck and provide most of the brain's blood supply. Strokes often result when accumulated plaque breaks off from a narrowed section of an internal carotid artery and blocks smaller vessels in the brain.

In the study, the carotid narrowing data came from vascular ultrasound tests performed on 307,444 tri-state area residents during 2003-2008 by Life Line Screening, a leading community-based health screening company focused on evaluating risk factors for vascular disease...The researchers' analysis showed that subjects in the top fourth of tri-state zip codes, ranked by average PM 2.5 levels, were about 24 percent more likely than those in the bottom quarter to have shown signs of stenosis—defined as a narrowing by at least half—in either internal carotid artery.

"Our study was a population study, so it can't establish cause and effect, but it certainly suggests the hypothesis that lowering pollution levels would reduce the incidence of carotid artery stenosis and stroke," says Dr. Newman. Scientists aren't yet sure how air pollution contributes to vascular disease. Studies have indicated that it may do so in part by causing adverse chemical changes to cholesterol in the blood, by promoting inflammation, and by making blood platelets more likely to form clots."

It has long been known that diesel exhaust has negative health effects. From Science Daily:

Researchers uncover a mechanism linking inhaled diesel pollution and respiratory distress

Researchers have, for the first time, shown how exhaust pollution from diesel engines is able to affect nerves within the lung...Diesel exhaust is a significant component of urban air pollution, containing a complicated mixture of gases and airborne particles. "Studies have shown that exposure to these diesel particles is associated with harmful health effects," says Mr. Robinson. "These particles are very small -- down to 20 nanometres in diameter -- and are therefore not only invisible to the naked eye, but can penetrate deep into the lungs.

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For years there has been discussion about curcumin's anti-inflammatory, anti-bacterial, and anti-cancer effects, but more research is needed (some trials are going on now). Curcumin is a chemical compound found in turmeric. Turmeric is a member of the ginger family. It is used as a spice and is a common ingredient in Indian cooking, but also used in Middle Eastern and South Asian recipes.From Medical Xpress;

Curcumin proved effective at combating cancer

WA scientists have helped re-affirm that curcumin, a chemical compound found in turmeric, is a safe and promising treatment for most cancers and other inflammation-driven diseases.The international review considered past clinical trials using curcumin to treat cancer patients and concluded curcumin was a safe and effective molecule to treat cancer.

A/Prof Sethi says curcumin is exceptionally effective for multiple myeloma patients and those suffering from the particularly lethal pancreatic cancer, for which there are no drugs. However, curcumin was not found to be as effective in breast cancer patients being treated with the chemotherapeutic agent cyclophosphamide. According to the research, curcumin can counteract the effect of cyclophosphamide.

A/Prof Sethi says curcumin is possibly the only drug that can be given at high doses—up to 12g—without any toxicity.... A/Prof Sethi says the only known side effect of the agent is blood thinning, and therefore advises against taking curcumin if undergoing surgery.

He recommends people use turmeric more often in everyday cooking. A/Prof Sethi says it would be ideal to combine curcumin with other drugs or natural compounds, like piperine, an alkaloid found in pepper to increase its bioavailabilty..

A/Prof Sethi says there is a lack of data to explain the underlying mechanism of its effect, however, it is known for its anti-inflammatory effects. "It has been shown that most chronic diseases, including cancer, are caused by inflammation and can be treated by anti-inflammatory agents."He says more work needs to be done to improve curcumin's viability, as body tissues quickly absorb it. 

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A lengthy review of homeopathy studies found that homeopathy is worthless, not effective, don't bother with it. This total lack of effectiveness also applies to those homeopathic products sold for sinusitis. Don't bother with them. If you think homeopathy has worked for you - it's probably the placebo effect, wishful thinking, or just the natural course of healing. From Smithsonian:

1,800 Studies Later, Scientists Conclude Homeopathy Doesn’t Work

Perhaps you remember when scientists debunked homeopathy in 2002. Or 2010. Or 2014. But now a major Australian study analyzing over 1,800 papers has shown that homeopathy, the alternative treatment that relies on super-diluted substances and the principle of “like cures like” is completely ineffective.

 

After assessing more than 1,800 studies on homeopathy, Australia’s National Health and Medical Research Council was only able to find 225 that were rigorous enough to analyze. And a systematic review of these studies revealed “no good quality evidence to support the claim that homeopathy is effective in treating health conditions.”

The Australian study, which is the first position statement relying on such an extensive review of medical literature, strikes the latest blow at a 200-year-old alternative treatment developed by a German physician with “no interest in detailed pathology, and none in conventional diagnosis and treatment.” The Washington Post reports that the study’s authors are concerned that people who continue to choose homeopathic remedies over proven medicine face real health risks—including the nearly 4 million Americans who use homeopathic “medicines.”

News of the Australian study comes on the heels of newly released National Health Interview Survey data showing a “small but significant” increase in the use of homeopathy during 2012. And recently, a Canadian homeopathic college came under fire for taking an anti-vaccination stance and promoting homeopathic “nosodes” as an alternative to vaccines.

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Can you have too high levels of vitamin D? The researchers themselves say that the results show there is a J shaped curve linking vitamin D levels in the blood and mortality - both too high and too low levels are linked to higher levels of mortality. From Science Daily:

High levels of vitamin D is suspected of increasing mortality rates

The level of vitamin D in our blood should neither be too high nor to low. Scientists have now shown that there is a connection between high levels of vitamin D and cardiovascular deaths.

In terms of public health, a lack of vitamin D has long been a focal point. Several studies have shown that too low levels can prove detrimental to our health. However, new research from the University of Copenhagen reveals, for the first time, that also too high levels of vitamin D in our blood is connected to an increased risk of dying from a stroke or a coronary.

"We have studied the level of vitamin D in 247,574 Danes, and so far, it constitutes the world's largest basis for this type of study. We have also analysed their mortality rate over a seven-year period after taking the initial blood sample, and in that time 16,645 patients had died. Furthermore, we have looked at the connection between their deaths and their levels of vitamin D," Professor at the Department of Clinical Medicine, Peter Schwarz explains.

The conclusion is clear: the study confirms that there is indeed a correlation between mortality rates and too low levels of vitamin D, but the new thing is that the level of vitamin D can also be too high.

"If your vitamin D level is below 50 or over 100 nanomol per litre, there is an greater connection to deaths. We have looked at what caused the death of patients, and when numbers are above 100, it appears that there is an increased risk of dying from a stroke or a coronary. In other words, levels of vitamin D should not be too low, but neither should they be too high. Levels should be somewhere in between 50 and 100 nanomol per litre, and our study indicates that 70 is the most preferable level," Peter Schwartz states.

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Anecdotal evidence has been saying this for years.From Science Daily:

Keep calm, anger can trigger a heart attack!

The risk of a heart attack is 8.5 times higher in the two hours following a burst of intense anger, researchers have found after investigating the link between acute emotional triggers and high risk of severe cardiac episodes. High levels of anxiety were associated with a 9.5 fold increased risk of triggering a heart attack in the two hours after an anxiety episode.

"The data shows that the higher risk of a heart attack isn't necessarily just while you're angry -- it lasts for two hours after the outburst. In the study, 'anger' was qualified as 5 and above on a 1-7 scale, referring to 'very angry, body tense, clenching fists or teeth, ready to burst', up to 'enraged, out of control, throwing objects'. Anger below this level was not associated with increased risk. "The triggers for these burst of intense anger were associated with arguments with family members (29 per cent), argument with others (42 per cent), work anger (14 per cent) and driving anger (14 per cent)," said Dr Buckley.

"Increased risk following intense anger or anxiety is most likely due to increased heart rate, blood pressure, tightening of blood vessels and increased clotting, all associated with triggering heart attacks," he said.

The study was an investigation of consecutive patients suspected of heart attack and confirmed by angiography reports at Royal North Shore hospital. Patients confirmed with acute coronary blockage were admitted, interviewed about their activities in the 48 hours before the onset of symptoms, and usual frequencies of activities were recorded for comparison.

"Although the incidence of anger-triggered heart attacks is around 2%, of the sample, those people were 8.5 times more likely to have a heart attack within two hours of the emotional episode. So while the absolute risk of any one episode triggering a heart attack is low, this data demonstrates that the danger is very present.