COMPOUND IN MEDITERRANEAN DIET HELPS PREVENT CANCER CELL DEVELOPMENT

New research suggests that a compound abundant in the Mediterranean diet takes away cancer cells' "superpower" to escape death.  Normal cells in the body have a regular life cycle and are programmed to die but cancerous cells do not die.  Instead, they continue to multiply generating tumors. 

New cellular research led by Dr. Andrea Doseff found that the antioxidant apigenin, rich in herbs of the Mediterranean diet, especially parsley, has the ability to alter a specific step in gene regulation, effectively “re-educating” cancer cells into normal cells that die as scheduled. They conducted their studies on breast cancer cells as well as other types of human cells.  Previous research also indicates that apigenin has strong anti-inflammatory and immune boosting properties.  In this study researchers found that it binds to an estimated 160 proteins in the human body, suggesting that it has multiple synergistic health effects.

What to do:  Apigenin is an antioxidant in the flavonoid family of plant compounds.  Diets rich in flavonoids have been linked to reduced inflammation and lower rates of many diseases.  The absolute best dietary source of apigenin is parsley (both the curled and Italian flat-leaf varieties in fresh and dried forms are excellent sources).  Other good dietary sources include celery, chamomile tea, cilantro/coriander, marjoram, licorice, oregano, rosemary, and tarragon.  So, cook with plenty of herbs.  Parsley is especially versatile.  With its light scent and fresh taste, it is a great addition to soup or stew, tomato sauce, pasta, pesto sauce, green salad, grain salad, seafood, potatoes, rice, poultry, beef, lamb, eggplant, and cheese dishes.

Adapted from article available at: 

http://researchnews.osu.edu/archive/apigenin.htm

http://www.medicalnewstoday.com/releases/260826.php

Source:

Arango D, Morohashi K,Yilmaz A, et al.  Molecular basis for the action of a dietary flavonoid revealed by the comprehensive identification of apigenin human targets.  PNA; published online May 22, 2013.  doi:10.1073/pnas.1303726110.  Available at: http://www.pnas.org/content/early/2013/05/17/1303726110.abstract

EXERCISE REDUCES BREAST CANCER RISK BY ALTERING ESTROGEN BREAKDOWN

Researchers have long noted a relationship between regular aerobic activity and lower breast cancer risk.  Why does activity decrease breast cancer rates?  Certainly regular activity helps to keep weight in check and extra weight is a risk factor for breast cancer.  Interestingly, a new study has uncovered another reason activity is seems to lower risk.  A recent clinical trial found that regular activity changes the way women's bodies metabolize estrogen.  Estrogen metabolites are known to influence breast cancer development and the researchers found that aerobic activity  increases certain estrogen metabolites that lower risk while also reducing other estrogen metabolites believed to increase risk.  This study is just one in a growing number pointing to the fact that regular activity has many subtle metabolic effects that have far reaching implications for our health beyond simply burning calories.

The study included 391 pre-menopausal inactive women.  They ranged in age from 18 to 30 and had BMI's ranging from 18 (slightly underweight) to 40 (obese).  Researchers randomly assigned half of the participants to remain inactive while the other half did 30 minutes of moderate-to-vigorous aerobic exercise five times a week for 16 weeks. Participants worked out on indoor machines such as treadmills and elliptical machines.  Researchers collected urine samples from women in both groups before and after completing the study. There were no significant changes in the estrogen metabolites of the women in the inactive control group but for the women in the exercise group, the levels of the beneficial estrogen metabolites had increased and the levels of  the harmful estrogen metabolites had declined.   

What to do:  Aim to do 30 minutes of cardiovascular activity 5 times per week.  This will help to reduce breast cancer risk as well as risk for heart disease, diabetes, and most other chronic diseases.  Other factors that reduce breast cancer risk include maintaining a healthy weight, limiting intake of unhealthy saturated fats, avoiding alcohol, consuming a diet rich in antioxidants (deep orange and dark green veggies seem especially beneficial), and maintaining a healthy vitamin D level (ask your doctor to check your vitamin D level and take a supplement if needed).

Adapted from articles available at:

http://www.nlm.nih.gov/medlineplus/news/fullstory_136635.html

http://www.medpagetoday.com/HematologyOncology/BreastCancer/38967

http://www.sciencedaily.com/releases/2013/05/130507061143.htm

Source:

Smith AJ, Phipps WR, Thomas W, Schmitz KH, Kurzer MS.  The effects of aerobic exercise on estrogen metabolism in healthy premenopausal women.  Cancer Epidemiol Biomarkers Prev. 2013 May;22(5):756-64. doi: 10.1158/1055-9965.EPI-12-1325.  Available at:  http://www.ncbi.nlm.nih.gov/pubmed/23652373?dopt=Abstract

CEREAL SOLUTIONS: HOW TO CHOOSE A HEALTHY CEREAL

Ample research indicates eating breakfast is associated with a healthier weight, lower rates of heart disease and diabetes, and overall better health.  Enjoying a bowl of healthful cereal for breakfast is an easy, no-brainer way to start your day with a serving of fiber-rich whole grains. But not all cereals are created equal, and some offer little more than a hefty dose of sugar and refined white flour. Here's some tips to ensure your bowl of cereal provides a healthy start.  

The milk - What to Look for:

Choose 1% or fat-free (skim):  Milk is naturally rich in protein and vital minerals including calcium and potassium.  It is also fortified with vitamin D and A.  Unfortunately whole milk is also high in unhealthy saturated fat.  To avoid artery clogging fats, choose non-fat/fat-free/skim or 1% fat milk.

Healthy options if you are lactose intolerant: If you find milk gives you gas and bloating, you likely lack the enzymes in your digestive tract necessary to breakdown the natural carbohydrate in milk, lactose.  In Lactaid milk (again opt for 1% or skim), the lactose has already been broken down and should be well tolerated.  Soy milk is also a healthy alternative to dairy milk as the fats in soy are healthy fats.  Just be certain when choosing a soy milk to opt for an unsweetened one as many are high in added sugar.  Compared to soy or dairy milk, almond milk is much lower in protein.  Look for a milk or milk substitute that has at least 7g of protein per cup. 

The cereal - What to Look for:

The front of cereal boxes are designed to sell cereal rather than provide you with the information you need to make a healthy decision.  Look at the Nutrition Facts label and ingredient list to size up a cereal.  The following nutritional criteria apply to ~1 cup of cold cereal or ~1/2 cup (dry) hot cereals (about 40g of cereal but note that in the case  of the finely ground cereals 40g is less than ½ cup dry) not including milk or fruit.

180 calories or less:  Note the serving size:  For cereals, the serving size listed on the nutrition facts labels ranges from 1/4 cup to 1 1/2 cups.  All the listed nutrition facts apply to the listed serving size, so when comparing cereals, first note the serving size.  Granola and muesli types of cereal often have small serving sizes listed.  For example, Kellogg's Special K Lowfat Granola has 190 calories per serving but a serving is only 1/2 cup - so that means per cup it has 380 calories!  Keep in mind that 1 cup of dense cereal contains more grain and will be more filling than an airier cereal so it is also useful to compare the grams per serving as well.  Note your portion size:  Another important factor in controlling calories is to watch your portion size.  Most bowls easily hold 2 cups of cereal.  If you are not mindful of your portion you may be having 2-4 times the listed calories per serving.  Using a small bowl has been shown to reduce the amount of cereal eaten.

4g of fiber or more:  Fiber helps with regularity, fullness, and slows digestion to help prevent blood sugar spikes.   The fibers that are best for regularity and health are intact fibers- fibers that are found in whole grain or bran (the outer layer of a grain that is richest in intact fiber) ingredients. Many cereals including the Fiber One line, have added isolated fibers such as inulin, polydextrose, oat fiber, or wheat fiber.  While these are also still healthy they do not help as much with regularity and may not contribute to heart health as much as intact fiber.  FYI, wheat bran is the best ingredient for regularity.

Whole grain or bran is first ingredient:  Looking at the number of grams of whole grains in a cereal can be misleading.  The ingredients are listed from greatest amount to least amount in a food, so look for options with a whole grain or bran (intact fiber) as the first ingredient.  In hot cereals all rolled oats or steel cut oats are whole.  If rice is not specified as brown than it is not a whole grain.  Grits and the original versions of Cream of Rice and Cream of Wheat are also not whole grain cereals. 

6g or less of added sugar per cup:  In some cereals, more than 50% of the calories per serving come from straight sugar!   When it comes to added sugar, less is better and none is best.  Keep in mind cane juice, honey, corn syrup, fructose, and brown sugar are all added sweeteners no healthier than sugar.  Instead of opting for pre-sweetened cereals, add your own fresh, frozen or dried fruits to give your cereal some sweetness.  You could also add your own sugar-free sweetener such as Splenda without adding calories.  Cereals with added raisins will have higher sugar content but may be low in added sugar.  Both Post and Kellogg’s Raisin Bran are good options.  If you want a pre-sweetened hot cereal, the sugar-free packets and Quaker’s line of “Lower Sugar” options are good bets. 

Less than 200g of sodium per cup:  Many cereals are very low in sodium while others have over 300 mg per serving.  The Kellogg's Chex line is one of the highest with as much as 425mg per cup!  Among hot cereals, many of the instant packets are higher in sodium.  For example the Quaker Weight Control packet has 240mg per packet while the Old Fashioned has 0mg per 1/2 cup dry.

Nutrition bonus - 6g or more of protein per cup: While cereals are grain-based and therefore mostly carbohydrate, many cereals are now formulated with added protein.  Protein is important for fullness and maintaining lean tissue when losing weight.  Special K Protein, Kashi Go Lean (cold cereal), and Kashi Go Lean Instant Packets are some of the healthiest options high in protein.

Here's a list of some of the healthier cold cereal options widely available in local grocery stores:

General Mills Cheerios Original

General Mills Fiber One 80 Calories Honey Squares

General Mills Fiber One Original

General Mills Fiber One Raisin Bran Clusters

General Mills Total Whole Grain

General Mills Wheaties

Kashi GO LEAN

Kashi Heart to Heart Warm Cinnamon Oat & Honey Toasted Oat

Kashi Squares Honey Sunshine

Kellogg's All-Bran

Kellogg's All-Bran Complete Wheat Flakes

Kellogg's Raisin Bran

Kellogg's Special K Protein

Newman's Own Sweet Enough Cinnamon Fiber Flakes

Post Bran Flakes

Post Grape-Nuts Flakes

Post Original Shredded Wheat Spoon Size or Big Biscuit

Post Raisin Bran

Post Wheat'n Bran Shredded Wheat Spoon Size

Quaker Life Crunchtime

Quaker Whole Hearts

CARNITINE FOUND IN MEAT & SUPPLEMENTS LINKED TO HEART DISEASE

Diets high in red meat are known to be associated with greater risk of heart disease.  The association between red meat and heart health has been thought to be mostly due to the unhealthy fats found in red meat that raise blood cholesterol levels and contribute to atherosclerosis, clogging of the arteries.  Now, new research has uncovered an additional way in which red meat consumption promotes atherosclerosis.  Researchers have found that when carnitine, a compound plentiful in meat, is broken down by bacteria in the digestive tract, a substance that promotes arterial inflammation and clogging of the arteries, trimethylamine-N-oxide (TMAO), is produced. 

The research, led by Dr. Stanley Hazen, tested the carnitine and TMAO levels of meat-eaters, vegans and vegetarians, and examined the carnitine blood levels of 2,595 patients undergoing elective cardiac evaluations. Among those undergoing cardiac evaluations, they found that high carnitine levels were consistently associated with a raised risk of heart disease, heart attack, stroke and heart-related death.  Also, in an experimental trial they fed steaks to persons who regularly ate red meat and measured levels of TMAO before and after the meal.  They found sharp increases in TMAO blood levels following the meal and also found similar results when feeding these persons carnitine supplements.  Next, participants were given a course of antibiotics to wipe out gut bacteria, and then again fed steaks, and, on another occasion, carnitine supplements.  After the antibiotic treatment, neither the steak nor the supplements increased TMAO levels, indicating that indeed it was gut bacterial producing the TMAO.

The type of bacteria living in one's digestive tract is strongly influenced by one's long-term dietary patterns. Researchers found that a diet high in carnitine shifts the gut microbe composition to the types that digest carnitine.  Thus, TMAO production is increased in meat-eaters. In contrast, researchers found that levels of TMAO and the bacteria which produce TMAO were very low in persons who were following a vegetarian (no meat, fish, poultry) or vegan (no animal products including no eggs and dairy) diet. 

It is believed that TMAO contributes to atherosclerosis because it enables blood cholesterol to get into artery walls and cause damage.  It is also believed to interfere with the body's ability to eliminate excess blood cholesterol.  Thus, a diet high in meat not only increases blood cholesterol but increases the harm caused by the higher levels of cholesterol. 

Dr.  Hazen, reports that he has taken his findings to heart. He had been a lifelong meat lover eating large portions several times a week, but, convinced by his findings, he now limits his intake to 4-6 oz. once every two weeks. 

What to do:  Besides meat, carnitine also occurs naturally in chicken, fish, and dairy but levels are much higher in red meat.  Carnitine is also added to energy drinks and supplements because it has been thought to help build muscle.  While meat is a great source of protein, iron, and B vitamins, because of the risk it poses to heart health, try limiting its consumption to 2 times per week or less.  Opt instead for lean protein sources such as fish, skinless poultry, lowfat/nonfat dairy, eggwhites, and beans.  Make sure to avoid supplements or energy drinks containing added carnitine.

Adapted from articles available at: 

http://www.nlm.nih.gov/medlineplus/news/fullstory_135662.html

http://www.sciencedaily.com/releases/2013/04/130407133320.htm

http://www.nytimes.com/2013/04/08/health/study-points-to-new-culprit-in-heart-disease.html?pagewanted=all&_r=0

Source:

Koeth RA, Wang Z, Levison BS, et al.  Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine; 2013.  Doi:10.1038/nm.3145.  Available at: http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.3145.html

MERCURY EXPOSURE LINKED TO RAISED DIABETES RISK

High blood mercury levels have been known to present a danger to developing fetuses and young children but new research - the first to link mercury and diabetes in humans - suggests that even moderate levels of blood mercury may increase adult’s risk of developing type 2 diabetes.  Researchers found that young adults who have higher levels of mercury in their systems may face a 65% increased risk of developing type 2 diabetes later in life.

The study tracked nearly 3,900 men and women between the ages of 20 and 32 for years.  At the start of the study participants were ages 20-32 and free of diabetes.   Mercury levels in their toenails were measured at the start of the study and then participants were tested for diabetes periodically throughout the study.  The main source of mercury in the diet is from seafood.  Not surprisingly, study participants with the highest levels of blood mercury reported higher intakes seafood.

These findings suggest all persons, not just pregnant mothers and young children, be mindful of their intake of fish containing high levels of mercury.  However, it would be a mistake to avoid all seafood because of mercury.  There is ample evidence that consuming more fish, especially fattier types of fish rich in essential omega-3 fatty acids, is associated with better health and longevity.  For example, a recent study that tracked 2700 older Americans over 16 years, found that those with the highest levels of omega-3 fatty acids in their blood were less likely to die from a range of causes (and especially heart disease) than those with the lowest levels.  On average, those with the highest levels of omega-3 fatty acids, lived two years longer than those with the lowest levels.

What to do:  Seafood is great source of lean protein, minerals and vitamins, and omega-3 fatty acids.  Aim to consume seafood at least twice a week.  Choose seafood that is rich in omega-3 fatty acids but low in mercury including salmon, herring, halibut, and sardines.  Fish that are highest in mercury include king & Spanish mackerel, swordfish, marlin, orange roughy, sea bass, shark, and tuna (skipjack & chunk light are lower).

Adapted from articles available at:

http://www.nlm.nih.gov/medlineplus/news/fullstory_135680.html

http://www.nlm.nih.gov/medlineplus/news/fullstory_135564.html

Sources:

He K, Xun P, Liu K, et al. Mercury exposure in young adulthood and incidence of diabetes later in life: The CARDIA trace element study. Diabetes Care, 2013.  Available at:  http://care.diabetesjournals.org/content/early/2013/02/14/dc12-1842.

Mozaffarian D, Lemaitre RN, King IB, et al. Long-chain ω-3 fatty acids and total and cause-specific mortality in older adults:  A cohort study. Annals of Internal Medicine, 2013 Apr;158(7):515-525.  Available at: http://annals.org/article.aspx?articleid=1671714.

DIETS HIGH IN SALT MAY INCREASE RISK OF AUTOIMMUNE DISEASES

Eating a diet high in sodium may do more than raise your blood pressure. Researchers report that it could also contribute to the development of autoimmune diseases, where the body's immune system mistakenly mounts an attack upon some part of the body.  Three new studies conducted on mice and human immune cell cultures, suggest salt may be a prime suspect in a wide range of autoimmune diseases, including multiple sclerosis (MS), psoriasis, rheumatoid arthritis and ankylosing spondylitis (arthritis of the spine).

Significant increases in the incidence of autoimmune diseases, especially multiple sclerosis and type 1 diabetes, suggests that environmental and lifestyle factors, and not just genetics, influence the onset of these diseases. Observational studies have shown that persons who eat more meals out and especially those who frequently eat fast food, have high levels of pathogenic helper T-cells (specifically helper T-cells 17),which are elevated in autoimmune diseases.  Helper T-cells 17 are a type of infection-fighting cell that is likely to become pathogenic, attacking tissues in the body rather than infectious agents. To investigate if high salt intake was possibly increasing these cell levels, Dr. David Hafler and his colleagues as well as researchers at other institutions, fed high salt diets to mice and exposed cultures of human T-cells to elevated levels of sodium.  In both cases, in the presence of sodium, helper T-cells differentiated into the pathogenic helper T-cells 17 at ten times the rate of those not exposed to high levels of sodium.  In fact,  the mice on high salt diets developed a severe form of multiple sclerosis, called autoimmune encephalomyelitis. 

While salt may play a role in autoimmune diseases, the researchers said the picture is most likely complicated. "We don't think salt is the whole story. It's a new, unexplored part of it, but there are hundreds of genetic variants involved in autoimmune disease and environmental factors, too," said Hafler.  In addition to salt, other factors have been shown to influence levels of pathogenic helper T-cells, including microbes, diet, metabolism, environmental factors and cytokines (proteins that help regulate inflammatory responses).

What to do:  While the relationship between salt and autoimmune disease has yet to be conclusively explored, there are plenty of other health benefits to limiting sodium intake.  High salt diets have been shown to raise blood pressure which increases risk for stroke, heart disease, and kidney disease.  High salt intake also is detrimental to bone health.   Daily sodium intake should be less than 2,300 mg of sodium a day (about 1 teaspoon of salt).  Limit your meals out because these are almost always high in sodium.  At home use lemon, herbs, and spices instead of salt to season foods.  Read labels to assess the sodium content of foods as most of our intake comes from salt added by manufacturers.  Deli meats, frozen dinners, boxed noodle and rice dishes, canned soups, canned vegetables, bottled dressings & sauces, bread, and snack foods all tend to be high in sodium. 

Adapted from article available at:

http://www.nlm.nih.gov/medlineplus/news/fullstory_134647.html

http://www.examiner.com/article/can-too-much-dietary-salt-set-families-up-for-developing-autoimmune-diseases

Sources: 

Kleinewietfeld M, Manzel A, Titze J, Kvakan H, Yosef N, et al.  Sodium chloride drives autoimmune disease by the induction of pathogenic TH17 cells.  Nature (06 March 2013)|doi:10.1038/nature11868.  Available at: http://www.nature.com/nature/journal/vaop/ncurrent/full/nature11868.html?WT.ec_id=NATURE-20130307

Wu C, Yosef N, Thalhamer T, Zhu C, Xiao S et al.  Induction of pathogenic TH17 cells by inducible salt-sensing kinase SGK1.  Nature (06 March 2013) | doi:10.1038/nature11984. Available at: http://www.nature.com/nature/journal/vaop/ncurrent/full/nature11984.html

Yosef N, Shalek AK, Gaublomme JT, Jin H, Lee Y, et al.  Dynamic regulatory network controlling TH17 cell differentiation.  Nature (06 March 2013) | doi:10.1038/nature11981. Available at: http://www.nature.com/nature/journal/vaop/ncurrent/full/nature11981.html

EVEN A DRINK A DAY BOOSTS RISK FOR CANCER AS WELL AS DANGEROUS IRREGULAR HEARTBEAT

Two new studies indicate that even very moderate alcohol intake can prove detrimental to our health.  In the first study, researchers found that intake as low as a drink a day increases the risk of dying from cancer, and, in the second, it was found that among those with heart disease, very moderate intake increases risk for atrial fibrillation, an irregular heart rhythm that can lead to stroke and/or heart failure.   

In the cancer study, researchers analyzed cancer mortality and alcohol intake data in the U.S. from 2009-2010 and found that 1 in every 30 cancer deaths can be attributed to alcohol consumption.  While heavy drinking increases cancer risk more than moderate intake, as much as 30% of all alcohol-related cancer deaths are linked to drinking 1 ½ or less drinks per day.   Alcohol appears to be an especially important risk factor for breast cancer where 1 in every 6 breast cancer deaths has been attributed to the increased risk that comes from alcohol consumption.  

Commenting on the study findings, lead investigator Dr. David Nelson stated “Alcohol is a cancer-causing agent that's in plain sight, but people just don't see it.  Moderate drinking has been associated with heart benefits, but, in the broader context of all the issues and all the problems that alcohol is related to, alcohol causes 10 times as many deaths as it prevents.  There is really no safe level of alcohol use.” 

Previous studies have shown drinking is a risk factor for cancers of the mouth, throat, esophagus, liver, colon, rectum and, in women, breast cancer.  It is believed alcohol acts as a chemical irritant to sensitive cells, impeding their DNA repair as well as increasing their vulnerability to other carcinogens such as tobacco smoke.  In women, alcohol’s impact on estrogen levels and estrogen receptors is believed to drive increases in breast cancer rates.   

Another recent study found that moderate alcohol consumption increases risk of experiencing atrial fibrillation (a-fib) among those with heart disease or diabetes.  Binge drinking has long been known to increase episodes of a-fib but the effect that moderate alcohol consumption has on rates of a-fib has been debated. 

Several studies have suggested that moderate alcohol intake - up to one drink a day for women, up to two for men can help to prevent coronary heart disease - where cholesterol-containing "plaque" builds up in the arteries.  However, this latest study suggests that when people already have heart issues, moderate drinking is actually tied to more A-fib cases. For five years, the study tracked more than 30,000 older adults who either had clogged arteries, a history of stroke, or diabetes with heart health problems. Most had coronary heart disease.  Researchers found that even after controlling for age, weight, and cigarette smoking, compared to those who abstained, those who were moderate alcohol consumers had a 14% increased risk for a-fib. 

Commenting on the findings, lead researcher Dr. Yan Liang wrote, “In general, experts say that if you're already a moderate drinker it's probably okay to keep it up.  But, for people with certain chronic health problems, the new results may question that guidance.  Our findings suggest that older individuals with cardiovascular disease or diabetes should probably limit their alcoholic beverages to no more than 1 drink per week".

What to do:  If you already abstain, continue to do so.  If you already have irregular heartbeat, a-fib, a history of stroke, congestive heart failure, or advanced heart disease it is usually advised that you avoid alcohol.  If you do not have advanced heart disease and you choose to drink alcohol, do so in moderation.  Even infrequent binge drinking has been shown to detrimental.  Moderate drinking means having up to one drink a day for women and up to two for men.  One drink is defined as 0.6-fluid ounces of pure alcohol which translates into about 10-ounces of beer, 4-ounces of wine or 1 ¼ ounces of liquor.  The antioxidants in red wine, believed to confer some of its associated heart health benefits, are also found in grapes, grape juice, blueberries, blackberries, mulberries, peanuts, and pistachios.

Adapted from articles available at:

http://vitals.nbcnews.com/_news/2012/10/03/14204194-moderate-drinking-linked-to-abnormal-heart-rhythm?lite

http://www.reuters.com/article/2012/10/03/us-moderate-drinking-idUSBRE89213L20121003

http://www.nlm.nih.gov/medlineplus/news/fullstory_134037.html

Sources:

Nelson DE, Jarman DW, Rehm J, Greenfield TK, Rey G, Kerr WC, Miller P, Shield KD, Ye Y, Naimi TS. Alcohol-attributable cancer deaths and years of potential life lost in the United States. American Journal of Public Health, Feb. 14, 2013, doi: 10.2105/AJPH.2012.301199

Available at: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301199?journalCode=ajph

Liang Y, Mente A, Yusuf S, Gao P, Sleight P, Zhu J, Fagard R, Lonn E, Teo KK, Alcohol consumption and the risk of incident atrial fibrillation among people with cardiovascular disease.  CMAJ October 1, 2012, doi:10.1503/cmaj.120412  Available at http://www.cmaj.ca/content/early/2012/10/01/cmaj.120412.abstract