EXCESS INTAKE OF VITAMIN E, SELENIUM, OR BETA CAROTENE MAY INCREASE CANCER RATES

 A consensus statement released by the U.S. Preventive Services and the results of a new study both find that there are potential downsides to taking some vitamins and minerals. 

A panel of experts was recently convened to give Americans better guidance on supplementation.  The 16-member panel took an in-depth look at studies conducted over the past 10 years on vitamins and minerals and found  there was no conclusive evidence multivitamin improve health.  The panel also stated healthy Americans should not take vitamin E or beta carotene supplements to help prevent heart disease or cancer and that, for smokers, beta carotene supplements may actually increase the risk of lung cancer.  In two large studies taking beta carotene increased the risk of lung cancer in smokers by 24%.  There is also limited evidence that taking high levels of folate can increase colon cancer rates.

Additionally, a large supplementation trial found men taking selenium or vitamin E supplements can double their risk of prostate cancer.  The study, begun in 2001, was prompted by early research suggesting the supplements might protect against prostate cancer. But, researchers found that taking selenium increased the risk of high-grade cancer by 91% among men with already high selenium levels.  Among men with low selenium levels, taking vitamin E increased the risk of prostate cancer by 63% and the risk of aggressive cancer by 111%.

Men can still take their daily multivitamin without fear, however.  The levels administered in this study significantly exceeded the recommended daily intake and were higher than would be found in most multivitamins.  During the trial, men took 200 mcg of selenium and 400 IU of vitamin E daily, either separately or in combination.  By comparison, the recommended daily intake of selenium for adults is 55 mcg, and for vitamin E it is 22 IU. 

What to do:  If you want to take a multivitamin it is likely doing no harm but it also may be doing no good.  As the study findings reveal, taking large doses of supplements can increase cancer risk.  Certainly, supplements are no substitute for eating a healthy diet, getting regular physical activity, and controlling body weight.  Instead of supplements aim for healthy foods naturally rich in vitamins and minerals.  To get adequate vitamin E and selenium aim for whole grains, nuts, and dark leafy greens.

Adapted from articles available at:

http://www.nlm.nih.gov/medlineplus/news/fullstory_144782.html

http://www.cancer.gov/newscenter/qa/2008/selectqa

Sources: 

Sources: 

Frankel PH, Parker RS, Madsen FC, Whanger PD.  Baseline selenium and prostate cancer risk:  Comments and open questions. Journal of National Cancer Institute. Available at dju060 doi:10.1093/jnci/dju060.

Kristal AR, Darke AK, Morris JS, et al.  Baseline Selenium Status and Effects of Selenium and Vitamin E Supplementation on Prostate Cancer Risk. Journal of National Cancer Institute.  Available at djt456 doi:10.1093/jnci/djt456 first published online February 22, 2014.

U.S. Preventive Services Task Force.  Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer.  Annals of Internal Medicine on 25 February 2014.  Available at: http://www.uspreventiveservicestaskforce.org/uspstf14/vitasupp/vitasuppfinalrs.htm#copyright

LEAVING THE WORKFORCE DETRIMENTAL TO HEALTH

A growing body of research indicates that leaving the workforce, whether one is retiring, going on disability, or simply cannot find work, has serious detrimental effects on mental and physical health.  Leaving the workforce changes one's physical environment as well as one's mental and physical activity patterns and researchers point out that these changes profoundly change individual's health behaviors, social interactions, psychosocial stresses.  

Retirement is often perceived as a golden opportunity to focus on healthy behaviors.  However, retirement, marked by reduced social interaction, less physical movement, and a loss of sense of purpose, actually increases the risk of health problems.  For example, a study published in 2008 by the National Bureau of Economic Research found retirement increased difficulties with mobility and daily activities 16%. A recent report published by the Institute of Economic Affairs in London concluded retirement , raises the risk of developing clinical depression by about 40%, increases the risk of developing at least one diagnosed physical condition by approximately 60%, and raises the risk of needing medication for a physical condition by 58%. 

Involuntary unemployment appears to be especially bad for health in the US where unemployed workers often lose health insurance.  It is estimated that in the United States, each percentage rise in unemployment leads to 6,000 deaths.  A review of more than 300 studies on mental health and unemployment found that unemployment was markedly linked to declines in mental health.  For instance, men who had lost jobs within the last four years were three times more likely than stably employed men to have recently abused alcohol. Likewise, women who had a stint of unemployment were three times more likely than other women to have suffered extended periods of depression.  According to a study out of Columbia University, long-term unemployment can reduce life expectancy by an average of 1 ½ years.   Parent’s unemployment even appears to have lasting effects on the success of their children.  A 2008 report based on a study that followed the earnings of 39,000 Canadian fathers and sons over 30 years beginning in the late 1970's found that when the sons of men who lost their jobs joined the workforce, they earned 9% less than the sons of otherwise comparable workers.

There is evidence that being out of the workforce is particularly damaging to heart and cardiovascular health.  A number of studies have found that persons in retirement or on disability decrease their amount of walking and other physical activity when they leave the workforce.  A recent study at the Harvard School of Public Health looked at rates of heart attack and stroke among men and women in the ongoing U.S. Health and Retirement Study. Among 5,422 individuals in the study, those who had retired were 40% more likely to have had a heart attack or stroke than those who were still working. The increase was most pronounced during the first year after retirement with mortality rates of the newly retired 50% greater.

What to do:  While the common perception is that if we could only quit our stressful jobs and focus on our health we would be better off, in fact, work is beneficial to health.  So, keep working as long as you can.  If you do leave the workforce, actively engage in behaviors that protect your health.  Foster a new social networks, pursue activities that keep you physically active and bring you joy, and continue to challenge your mind with structured and unstructured learning.  

Adapted from articles available at:

http://www.livescience.com/13578-unemployment-health-mortality.html

http://www.bloomberg.com/news/2013-06-11/retirement-will-kill-you.html

http://www.medicalnewstoday.com/articles/260622.php

http://www.health.harvard.edu/blog/is-retirement-good-for-health-or-bad-for-it-201212105625

http://consumer.healthday.com/encyclopedia/article.asp?AID=646671

http://economix.blogs.nytimes.com/2012/03/28/the-enduring-consequences-of unemployment/?_r=0

http://thinkprogress.org/economy/2012/04/02/456809/long-term-unemployment-decreases-life-expectancy/

Sources:

Centers for Disease Control and Prevention.  Current Depression Among Adults --- United States, 2006 and 2008. Mortality and Morbidity Weekly Report.  October 1, 2010 / 59(38);1229-1235

Paul K, Moser K. Unemployment impairs mental health: Meta-analyses. Journal of Vocational Behavior. Volume 74, Issue 3 June 2009

Jin RL. The impact of unemployment on health: a review of the evidence. Can Med Assoc J. 1995 Sept 1; 153(5)529-539.

Warr, PB. Work, Unemployment and Mental Health.  New York, Oxford University Press. 1987.

Warr, PB. Self-esteem and unemployment among young workers.  Le Travail Human.  1983,

46,355-366.

INTAKE OF OMEGA-3 FATS FOUND IN FISH MAY HELP PRESERVE BRAIN HEALTH

A recent study found older women with higher blood levels of the fats found in oily fish (such as salmon and tuna) experienced less age-related brain shrinkage than women with lower levels of fish oil fats. Normally, with age, the brain shrinks about half a percentage point every year after age 70 and those with dementia experience much greater brain shrinkage. 

For the study, Dr. James Pottala and colleagues analyzed data from the Women's Health Initiative Memory Study that included 1,111 senior women who had no signs of dementia at the beginning of the study. Their blood levels of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were measured at the start of the study.  Eight years later, the women had MRI scans that measured their brain volumes. The researchers found women with the highest EPA and DHA blood levels at the study's outset had brains that were about two cubic centimeters larger overall than women with the lowest levels.  In addition, the hippocampus, a brain region critical in forming and storing memories and one of the first areas of the brain that shrinks with Alzheimer’s, was 2.7 % larger in women who had fatty acid levels twice as high as the average.  The analysis controlled for other factors that can influence women's brain size, including education, age, other health conditions, smoking and exercise.

While this study did not prove a causal relationship between omega-3 intake and brain preservation, it is plausible intake of these fats, which our bodies cannot synthesize but have to get from oily fish, could affect brain volume.  DHA accounts for 30%-40% of the fatty acids in brain cell membranes, and it is especially concentrated near the synapses where nerve cells communicate with one another. 

What to do:  Fish high in omega-3 fatty acids include salmon, herring, mackerel, tuna, and sardines. To maintain blood levels comparable to the study’s participants with high blood levels, one would need to eat fatty fish or take a fish oil supplement most days of the week.    

Source: 

Pottala JV, Yaffe K, J. G. Robinson JG, Espeland MA, Wallace R, & Harris WS.  Higher RBC EPA DHA corresponds with larger total brain and hippocampal volumes: WHIMS-MRI Study. Neurology, online January 22, 2014. Available at DOI:10.1212/WNL.0000000000000080 

Adapted from articles available at:

http://www.sciencedaily.com/releases/2014/01/140122170541.htm

http://www.sciencenewsline.com/articles/2014012312480001.html

EVEN WITHOUT WEIGHT GAIN, CONSUMPTION OF ADDED SWEETENERS INCREASES RISK OF DYING FROM HEART DISE

A recent analysis from the Center for Disease Control indicates regular consumption of too much sugar and other added sweeteners increases the risk of dying from heart disease, even when one maintains a healthy weight. The study also concluded that most Americans are consuming far more sugar than is recommended.

The results are based on data collected from the National Health and Nutrition Examination Survey which has tracked the eating patterns of over 31,000 U.S. residents from 1988 through 2010.  The study found that over the period of the survey, the average adult took in about 16% of their calories from added sweeteners, and 10% of adults got more than 25% of their calories from added sweeteners.  The natural sugars in juice were not included in the study although it is likely these impact the body similarly to added sugars.

The study found that compared to people who got less than 10% of their daily calories from added sugars, those taking in 10-25% of their calories from added sugar were 30% more likely to die of cardiovascular disease during the study period. And, those who got 25% or more of their calories from added sugar were more than twice as likely to die of cardiovascular disease.  The relationship between sweetener consumption and cardiovascular related death rates was independent of other factors known to impact heart health including weight, smoking, age, gender, physical activity, socioeconomic status, and other aspects of an unhealthy diet.

Added sugars include all caloric sweeteners that are incorporated into foods including brown sugar, syrup, and honey.  Sugar-sweetened beverages are by far the single largest source of added sugar in the American diet, accounting for 37.1% of all that is consumed nationally.  A typical can of regular soda contains 35-40 grams of sugar (7-8% of a 2,000 calorie diet) while a 20-oz bottle has 65-75g of sugar (13-15% of a 2000 calorie diet).  How much sugar intake is too much?  This is still a matter of debate.  The Institute of Medicine recommends added sugars make up less than 25% of a person's daily calories, while the World Health Organization suggests the limit should be much lower, no more than 10% of caloric intake.  And, the American Heart Association sets the limit for added sugars at 100 calories per day for women (about 6 teaspoons) and 150 calories (about 9 teaspoons) per day for men.  This study's results corroborate the recommendations from the American Heart Association, limiting sugar to no more than 15% of caloric intake. 

Aside from leading to weight gain, excessive intake of added sugar appears to negatively affect health in several ways. It has been linked to the development of high blood pressure, increased triglycerides (blood fats), low HDL (good) cholesterol, fatty liver problems, as well as making insulin less effective in lowering blood sugar. 

What to do:  Avoid added sugar as much as possible.  Even at a healthy weight, a daily 20-oz serving of soda alone puts you over the limit of sugar intake.  Beware not only of foods we typically think of as sweets.  "Healthy foods" such as granola bars, cereal, sauces, canned & dried fruit, and yogurt contain substantial amounts of added sweeteners.   

Article adapted from:

http://www.medpagetoday.com/Cardiology/Prevention/44114

http://www.reuters.com/article/2014/02/03/us-sugar-diet-idUSBREA121IK20140203

http://www.usatoday.com/story/news/nation/2014/02/03/added-sugars-heart-disease-death/5183799/

Source:

Yang Q, Zhang Z, Gregg EW, Flanders W, Merritt R, Hu FB. Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Intern Med. 2014;():. bit.ly/1bW7SpA

THE TRUTH ABOUT CHOCOLATE & HEART HEALTH

Valentine’s Day is a big chocolate holiday.  With the frequent chocolate-is-good-for-you stories in the media we might think we are doing our health a favor by digging into a box of chocolates.  But, is chocolate really good for us?  Pure cocoa bean powder, the nonfat portion of the bean is rich in healthy antioxidant flavanols.  However, the amount of pure cocoa in your favorite chocolaty treats is likely not enough to help your health while the amount of cocoa butter (the fat component of the cocao bean), fats and sugar does add up to a serious serving of calories and cholesterol raising saturated fats.

The cocao bean is one of the richest food sources of a group of plant substances called flavanols.  Other foods, such as tea, red wine, berries, and some fruits, especially the skins of apples, contain flavanols but none is as high concentrations as the cocoa bean.   Chocolate, as we know it, is a combination of cocoa bean powder, cocoa butter and other fats, and sugar.  In the finished product, there is actually not that much cocoa bean powder.  And, unfortunately, the flavanol content takes a hit when raw cocoa beans are converted into chocolate. How big a hit depends on how the cocoa is processed. 

A closer look at the research on chocolate & health…

© Blood Flow:  There is good evidence that consumption of large amounts of flavanols consistently improves blood vessel wall function in individuals regardless of whether they are young and healthy or have coronary artery disease, diabetes or high blood pressure.  It appears that flavanols increase the body's ability to synthesize nitric oxide, which triggers the dilation (relaxing) of arteries and allows for increased blood flow.  When arteries do not dilate but are stiff the heart has to work harder. In a study funded by chocolate maker Hershey, researchers found that blood flow in the arteries increased within two hours after older people consumed high doses of flavanols (180, 465, or 1,095 mg), but not in those who got 70 mg.

© Blood pressure.  A 2012 review of 15 randomized controlled trials that lasted from 2 to 18 weeks concluded that a high consumption of flavanols (an average of 560mg per day which is equivalent to the amount in almost 3 Hershey's Dark Chocolate bars) can lower blood pressure by 2-3 mm Hg in the short term.

© Weight Loss: There have been some observational surveys that have sampled individuals and found that those who weigh less also report consuming more chocolate.  This has led some to conclude that chocolate helps with weight loss.  However when the persons in the studies who have a weight-associated illness such as diabetes or heart disease are excluded from the analysis, the association of chocolate eating with less weight disappears.  Researchers hypothesize heavier participants are eating less chocolate because they're trying to eat healthier given their health problems.   

And, in studies that happen over a period of time, the opposite trend emerges – with higher chocolate consumption comes more weight gain.  For example, more than 12,000 U.S. residents aged 45-64 were weighed in the late 1980s and were asked, among other things, how often they ate a serving of chocolate. Six years later, they were weighed and asked about chocolate again. In this study over time, greater chocolate consumption was linked to greater weight gain and those eating the most chocolate gained the most weight.  People who consumed just an ounce of chocolate at least once a week gained an average of 2.4 pounds over the six years. 

Getting your flavanols fix...

So, while getting at least 200mg of flavanols per day can improve blood flow and blood pressure, eating chocolate will not necessarily add that many flavanols to your diet because processing cocoa beans destroys flavanols. How much is lost depends on the beans and the processing.  Labeling a chocolate bar as having, say, “70% cacao” is not a reliable guide to the amount of flavanols because one cannot tell how heavily that cocoa was fermented or processed, both of which destroy flavanols.

How to get 200 mg? Two ounces of dark chocolate would probably do but keep in mind it comes with an average of more than 300 calories.  Many cocoa mixes contain cocoa that has been "processed with alkali" (also called "Dutch-process") and this process effectively destroys the all flavanol content.  Milk chocolate has less cocoa and more sugar than dark chocolate, so it would take 10 ½ oz. (almost 1,600 calories' worth) to give you 200 mg of flavanols! 

A better calorie option is half an ounce of baking chocolate for 70 calories or two tablespoons of an unsweetened pure cocoa powder (like Hershey's or Nestle Toll House, which have around 20 calories). Try mixing these into your coffee, warm milk, oatmeal, or yogurt. Also, Mexican mole sauces are a flavorful way to incorporate unsweetened cocoa into your diet.

Article adapted from: Nutrition Action Healthletter, December 2013, pg.8-11.

GUT BACTERIA MAY IMPACT BODYWEIGHT

Evidence is mounting of the importance of our gut bacteria to not only to our digestive health but that of all our body systems.  Interestingly, several recent studies suggest the composition of gut bacteria in our systems influence the likelihood of becoming obese.  For example in a recent study coordinated by Dr. Dusko Ehrlich researchers monitored the gut bacteria of 169 obese and 129 non-obese individuals.  They found that the gut bacterial in the obese people were less diverse and had more metabolic irregularities than in those at a healthy weight.  Even more striking, those with the least diverse gut bacteria gained more weight.  In another study from France, researchers monitored gut bacteria in 49 overweight and obese people when they were put on a weight loss diet that was low in fat and high in protein and fiber-rich fruits and vegetables.  Before the dietary intervention the participants had relatively low diversity within the their gut bacteria but with the dietary changes, the bacteria make-up of the overweight and obese persons diversified and came to more closely resemble the bacteria of lean persons. 

The relationship between gut bacteria and weight gain remains unclear but the research suggests that the metabolisms of the gut bacteria themselves are connected to the overall metabolism in the humans where they live. This means that disruption of the bacteria in the gut by use of antibiotics or eating foods that help only particular bacteria grow can have effects upon our entire bodies and how we gain weight. 

What to do:  While our understanding of the role gut bacteria play in weight gain and other health problems is still in its infancy, there no question healthy bacteria are essential to our digestive systems' function.  Eating a plant-rich diet appears to support a healthy mix gut bacteria.  Eating a diet rich in healthy probiotics (foods containing healthy bacteria) such as lowfat/nonfat yogurt also helps to support the population of healthy bacteria in your gut.

Adapted from article available at:

http://www.nlm.nih.gov/medlineplus/news/fullstory_140159.html

Sources:

Le Chatelier E,  Nielsen T, Qin J, et al. Richness of human gut microbiome correlates with metabolic  markers.  Nature 500, 541-546. (Aug. 29, 2013).  Available at:  http://dx.doi.org/10.1038/nature12506.

Cotillard A, Kennedy SP, King LC et al.  Dietary intervention impact on gut microbial gene richness.  Nature 500, 585-588 (29 August, 2013).  Available at:  http://dx.doi.org/10.1038/nature12506.

MEDITERRANEAN DIET RICH IN OLIVE OIL HELPS PREVENT DIABETES

A large recent study from Spain reports that sticking to a Mediterranean-style diet rich in olive oil, nuts, fish, beans, fruits and vegetables helps reduce the risk for Type 2 diabetes, even when people don’t lose weight or increase exercise levels.

The study included 3,541 men and women ages 55-80 who were at high risk for heart disease but did not have diabetes.  Participants were assigned to one of three diets: a Mediterranean diet supplemented with two ounces (approximately 3 tablespoons) of extra-virgin olive oil daily, a Mediterranean diet supplemented with 1 oz. (about 1/4 cup) of nuts daily, or a control group directed to eat a lowfat diet. 

After 4 years, compared with the control group, and after adjusting for health and socioeconomic factors, compared to the control group the risk for diabetes was 40% lower with the Mediterranean diet supplemented with olive oil and 18% lower for the diet supplemented with nuts.

What to do:  Consume a diet rich in nuts, fruits, vegetables, beans, fish, and lean poultry.  Aim to minimize your intake of full-fat dairy, heavy meat, refined grains, and sugary products.  Nuts and olive oil are special standouts but still keep portions moderate to prevent weight gain.  While this study points out that healthy diet choices even without weight loss can reduce the risk of diabetes, maintaining a healthy weight and regular activity are still the most important ways to prevent diabetes. 

Adapted from articles at:

http://www.webmd.com/diabetes/news/20140106/mediterranean-diet-alone-may-lower-diabetes-risk

http://well.blogs.nytimes.com/2014/01/13/mediterranean-diet-for-diabetes/?_php=true&_type=blogs&_r=0

http://www.medicalnewstoday.com/articles/270839.php

Source:

Salas-Salvadó J, Bulló M, Estruch R, et al. Prevention of diabetes with Mediterranean diets: A subgroup analysis of a randomized trial. Annals of Internal Medicine. 2014 Jan;160(1):1-10.