Eat More Antioxidants!

A Swedish study from the Karolinska Institute in Stockholm has confirmed the benefits of antioxidant consumption in the prevention of stroke – at least in women.  It’s published online in the journal Stroke.  So maybe some of the claims for these ‘nutrichemicals’ are indeed true?

The subjects in the study came from the Swedish Mammography Cohort.  Diet at baseline was assessed using a food frequency questionnaire, and the total antioxidant capacity of the diet was calculated from the oxygen radical absorbance capacity of the individual food items.  Stroke cases in the study population during follow-up were ascertained using the national hospital discharge registry. 

A total of 36,715 women were enrolled - 31,035 of them had no history of cardiovascular disease, and 5,860 had a history of such disease at baseline. Their ages ranged from 49 to 83 years.  The average follow-up period was 11 years, during which time 1,322 cases of stoke were recorded in the cardiovascular-free women (988 ischemic strokes, 226 hemorrhagic, and 108 unspecified strokes), and 1,007 strokes in women with a cardiovascular history (796 ischemic, 100 hemorrhagic, and 111 unspecified strokes).

Both groups of patients were categorized into 5 classes, or quintiles, according to their total antioxidant capacity at baseline.  In the women without prior cardiovascular disease those in the quintile with the highest antioxidant intake had a 17% lower risk of having a stroke than those in the lowest antioxidant intake quintile.  In the women with a cardiovascular history, the highest quintile had a non-significant decrease in total stroke risk (10%, not statistically significant), but there was a 45% decreased in the risk for hemorrhagic stroke.   

The subjects in the highest antioxidant quintile ate twice as much fruit and vegetables and drank 17 times more tea than those in the lowest quintile.  The findings from this study, and from an analysis from the Rotterdam Study, suggest that the antioxidant capacity of the diet is important in helping prevent stroke.  It’s also important to note that the benefits only accrue with an antioxidant-containing diet, not with antioxidant supplements.  So eat plenty of fruit, berries, nuts, and veggies; the list of antioxidant foods is long.

Statins and the Risk of Diabetes – What to Do?

The media have greeted the arrival of generic Lipitor with reports of a study appearing this month in the Archives of Internal Medicine.  Analyses of data from the Women’s Health Initiative (WHI) prove further evidence of a link between the use of statin drugs and the occurrence of diabetes in postmenopausal women.  But the study is not the first to suggest such an association.  An analysis of 13 randomized clinical studies, published in the Lancet in 2010, found that statin users had a 9% increased risk for diabetes. Another meta-analysis of 5 controlled studies, published in the Journal of the American Medical Association last June, described an increase in risk in patients taking high rather than moderate doses of statins.

The new study echoes the findings of the two earlier ones.  Almost 154,000 women from the WHI, with an average age of 63, were followed for 12 years, during which time 10,200 of them had developed type 2 diabetes.  Statin use, which was recovered at enrollment and after 3 years, was established in 7% of the participants.  After adjusting for potential confounding factors (e.g. family history, excess body weight), it emerged that statin users were 1.48-times more likely to develop diabetes than non-users;  the rate for new diabetes during the study rose from 6.4% in the women not taking statins to 9.9% in the statin users.  This increased risk applied to all the statin drugs taken.

Taken together, these reports show a clear relationship between statin use and diabetes, but it is not a very close association.  Statins have a proven beneficial effect on heart attack, stroke, and mortality in patients with cardiovascular risk factors (e.g. high blood pressure, obesity, or existing diabetes), but these benefits are less obvious in healthy people.  As one expert has put it: “Every woman taking a statin needs to know her risk of heart disease, and she should ask her doctor if the statin is really necessary.” 

It’s probable that the study finding applies equally to men, although we shall have to wait for another study to show this.  In the meantime, there’s one important conclusion to be drawn: statins shouldn’t be given to perfectly healthy people, as some have suggested (“they should put it in the water”).  And the dose should be kept as low as possible in order to achieve the desired effect on blood lipids.  A piece on the USA Today website summarizes the situation pretty well.

Death of a Loved One May Trigger a Heart Attack

This is an excellent example of the dangerous effect of severe psychological stress; it’s not been studied systematically before, although anecdotes abound.  Now scientists from Harvard Medical School have published the results of their study of heart attack (MI) survivors in the journal Circulation.    

The known increased likelihood of a spouse’s heart attack shortly after the death of a partner could possibly be related to their common lifestyle risk factors.  To avoid this confounding factor, the scientists employed a case-crossover study design, which compares each person with him- or herself as ‘controls’.  Data came from the multicenter Determinants of MI Onset Study (MIOS), and contained information on 1,985 heart attack patients – 66% were male, average age 61 years.  In 270 (13.6%) of the patients the death of a significant person was reported in the previous 6 months. (The term “significant person” represents a relative, friend, sibling, parent, spouse, or child.)  And 19 patients reported a significant death occurring within 24 hours of the onset of their heart attack; 7 within 24 to 48 hours; 5 within 48 to 72 hours; and 21 within 4 to 7 days. 

Calculations of the risks of having an MI were made for each of these periods, and compared with the individual’s ‘normal’ risk.  It was found that the incidence of heart attack was increased 21-fold within 24 hours of a significant death, and though it declined on each subsequent period measured, it remained 6-fold higher than normal the first week after bereavement.

To quote the principal author of the study: “Bereaved individuals and their family and friends should be aware of the heightened risk in the days and weeks after hearing of someone close dying”.  This may include taking already-prescribed meds, with perhaps addition of a sedative, aspirin or a beta-blocking drug if the individual has cardiovascular risk factors, such as high blood pressure.

Fruit and Veggie Lovers Can Still Gain Weight . . .

This is an appropriate follow-up to my post last week: “It’s the Calories, Stupid!”  A large European study, reported in the American Journal of Clinical Nutrition, assessed dietary intake in 373,800 participants from 10 countries at baseline.  This was the European Prospective Investigation into Cancer and Nutrition study.  Body weight was measured at baseline and self-reported at follow-ups.  Follow-up averaged 5 years.  Attention was focused on weight changes in association with fruit and vegetable intake.  People with chronic diseases and those who were likely to misreport calorie intake were excluded from the analyses.

The participants in the study gained about one pound a year, on average, over the 5 years.  After appropriate adjustments for any differences in age and gender between groups, analyses showed that baseline fruit and vegetable intakes were not associated with weight change overall; however, they were linked with weight changes in participants who quit smoking during follow-up. Higher fruit and vegetable intakes were linked to less weight gain in people who quit smoking during the study.

The investigators speculate that healthy eating habits (i.e. more fruit and veggies) may help prevent the weight gain many smokers experience when they try to quit.  So this study may offer would-be quitters encouragement to improve their dietary habits.  However, it doesn’t provide any evidence that a fruit/vegetable diet will help stop weight gain in the majority of people.  Calories are still king!

Who Gets Glaucoma?

Glaucoma is the second most common cause of blindness in the USA, and is being diagnosed more often, now that visits to ophthalmologists have increased.  In glaucoma, slowing or blockage of the flow of fluid in the front chamber of the eye causes pressure to build up in the eye. This raised intraocular pressure (IOP) causes damage to the optic nerve.

The exact cause of the most common type, open-angle glaucoma, is unknown, but a frequent first step is accumulation of exfoliated material from damaged cells lining the front chamber – so-called exfoliation glaucoma.  Open-angle glaucoma tends to run in families; and people of African descent and Europeans are at particularly high risk.  More is now known about the likely risk of contracting glaucoma in the USA, thanks to a study from Boston ophthalmologists published in the journal Ophthalmology. 

The researchers used data from 78,000 women in the Nurses’ Health Study and 41,000 men in the Health Professionals Follow-up Study.  They were over 40 at baseline, and free of glaucoma at entry.  Place of residence at age 15 and throughout the study was recorded.  The duration of follow-up was at least 20 years.

The risk of developing exfoliative glaucoma was strongly age-related: subjects 75 or older had a 44-times greater risk than those aged 40 to 55.  A positive family history of glaucoma was associated with a more than doubling of risk.  And men were 68% less likely to develop glaucoma than women.  However, no increased risk was found to be associated with ancestry, particularly Scandinavian ancestry.     

Compared with those living in the northern tier of the USA, lifetime residence in the middle tier was associated with a 47% reduced incidence, and living in the southern tier with a 75% reduction in risk. 

This large study has confirmed a lot of what we knew about the risk of developing the most common type of glaucoma, and added a new possible factor - place of residence.  Living in the south was linked with a significantly reduced risk, with a lesser (but still significant) benefit for dwellers in the middle tier of the USA.  The investigators postulate that lower ambient temperatures in the north interact with increased solar exposure to increase the risk of exfoliative glaucoma.     

Whatever your apparent risk of glaucoma, make sure you have regular eye exams by a recognized specialist – it’s well worth it.

Mental Decline Starts around 45

Most of us have accepted that there’s likely to be some loss of mental faculties in old age, but we also hope that we’ll dodge the devastation brought by Alzheimer’s disease or other forms of dementia.  In recent decades, however, researchers have demonstrated ‘cognitive decline’ as part of the normal aging process.  Now we learn that this sets in much earlier than we expected.  This is brought out in a study from University College, London, and published online in the British Medical Journal.

Data came from the Whitehall II Study, in which 5,000+ men and 2,000+ women who were aged 45 to 70 at enrollment in 1997-1999 were followed for 10-year periods.  During this time they underwent tests of memory, reasoning, vocabulary, listening skills, and recall, three times over a 10-year period.

The participants were classified into 5 age categories according to their baseline age: 45-49, 50-54, 55-59, 60-64, and 65-70 years.  All the cognitive test scores, except vocabulary, showed declines in all 5 age categories.  Moreover, there was faster decline in the older categories.  For instance, the 10-year decline in reasoning ability in men aged 45 to 49 at baseline was -3.6%, while it was -9.6% in men aged 65-70 at baseline.  In women, the corresponding decline was -3.6% and -7.4% for the same two age categories.

All the participants were civil servants, i.e. government office employees; and most of them were white and married.  However, it’s highly likely that these findings are applicable to other races and social categories.

What are the implications of this new knowledge?  It’s known that lifestyle factors and cardiovascular risk factors affect the likelihood of earlier cognitive decline.  However, now that we know that the problem starts at 45 (or thereabouts), it’s clearly important to address such factors as high blood pressure, overweight/obesity, and high cholesterol levels at an age when their control are most likely to be beneficial for cognitive function, i.e. before degeneration of nerve cells has begun. . .

It’s the Calories, Stupid!

The recent holidays have left their gift of several, if not 6 or more pounds’ extra body weight.  The afflicted will wonder why this happened, when they were careful to eat high-protein foods, low-protein foods, low-carb foods, or mostly fruit and veggies; surely they should have avoided holiday weight-gain?   A new study from the Pennington Biomedical Research Center, Baton Rouge, reported in the Journal of the American Medical Association, shows that it’s the number of calories that matter when overeating is concerned, not the composition of the food.

After eating a weight-stabilizing diet for 13 to 25 days, healthy young volunteers were randomized to switching to diets with 5% of their energy from protein (low protein), 15% (normal protein), or 25% (high protein).  They were then encouraged to overeat for 8 weeks, increasing their overall energy intake by about 40%, or almost 1,000 additional calories per day.  Body composition was measured using dual-energy x-ray absorptiometry, along with appropriate methods for energy expenditure.

There were 16 men and 9 females in the study, aged 18 to 35, with a starting body mass index (BMI) between 19 and 30, i.e. “normal” or “overweight”.  All the subjects gained weight, but those in the low-protein group gained less than those eating normal or high-protein diets (7.0 lb vs. 13.3 lb and 14.4 lb, respectively).  However, this was apparently largely due to a lower gain in lean body mass in the low-protein than in the other two groups (1.5 lb vs. 6.3 lb and 7.0 lb, respectively).  This is borne out by the overall increase in fat mass, which was similar in all 3 groups, about 7.7 lb above baseline.  In other words, a low-protein diet can mean less weight gain, but increased levels of body fat.  As the researchers summarize: “Calories alone accounted for the increase in fat; protein affected energy expenditure and storage of lean body mass, but not body fat storage”.

Further support for the relative unimportance of diet constituents, compared with their calorie content, comes from a review in US News.com of the 25 ‘best’ diets.  The relative small difference between the different diets shows that actual calorie intake trumps just about all other dietary changes if you want to lose or maintain weight loss. 

Look elsewhere on the US News diet site for ways to reduce your hunger . . .

A Different, but Effective, Drug for Fibromyalgia

Milnacipran (Savella®) has been approved by the FDA for the management of fibromyalgia.  The pharmacological description is ‘a selective serotonin and nor-epinephrine reuptake inhibitor’, and its unique feature is an apparent duration of effectiveness for up to 3 years.  A report at the recent meeting of the American College of Rheumatology described a clinical study that enrolled more than 1,200 patients.

The study was run in 4 phases: a 2-week washout period (i.e. no medications at all), a 2-week dose-increasing period, 8 weeks on a constant dose, and finally flexible dosing of 50 to 200 mg of milnacipran daily for the rest of the 3-year study. 

The average age of the participants at enrollment was 50.  Over 95% of them were women, and 93% were white. Their average body mass index (BMI) was 30.7, i.e. verging on the obese.  Their score on the pain scale was 64, which represents a pain that is “difficult to ignore”.

A total of 820 patients completed one year of the study, 462 completed 2 years, and 217 completed 3 years.  This demonstrates one problem of fibromyalgia – it’s difficult to keep patients on therapy.  Of those treated for one year, the average reduction in pain score was 17.5 points; at the 3-year visit, the average score showed a 24 point decrease.

These findings, in a non-controlled study, suggest that a fair number of patients failed to benefit from the chosen medication sufficiently to keep them in the study – the drop-out rate was higher each year.  However, those that did continue for 3 years achieved a better treatment result than those who dropped out early.  In other words, the test drug seems to work well for some patients, but not for all, and in those whom it does help, significant benefits persists for at least 3 years.  That’s quite something in this difficult-to-treat disease.