health

Good news for barflies! Time reports on new research into alcohol and life expectancy, which not only shows that moderate drinkers live longer, but that even heavy drinkers live longer than total abstainers.

...[A]fter controlling for nearly all imaginable variables — socioeconomic status, level of physical activity, number of close friends, quality of social support and so on — the researchers (a six-member team led by psychologist Charles Holahan of the University of Texas at Austin) found that over a 20-year period, mortality rates were highest for those who had never been drinkers, second-highest for heavy drinkers and lowest for moderate drinkers.

The sample of those who were studied included individuals between ages 55 and 65 who had had any kind of outpatient care in the previous three years. The 1,824 participants were followed for 20 years. One drawback of the sample: a disproportionate number, 63%, were men. Just over 69% of the never-drinkers died during the 20 years, 60% of the heavy drinkers died and only 41% of moderate drinkers died.

A key factor here is that the study accounted for the difference between people who never drank, and those who had problems with the bottle and then quit. It still found that moderate alcohol consumption is beneficial.

The New York Times reports on how mixing up medical tubes (IV tubes, gastric tubes, oxygen tubes, and so on) is injuring and killing patients:

Hospitalized patients often have an array of clear plastic tubing sticking out of their bodies to deliver or extract medicine, nutrition, fluids, gases or blood to veins, arteries, stomachs, skin, lungs or bladders.

Much of the tubing is interchangeable, and with nurses connecting and disconnecting dozens each day, mix-ups happen — sometimes with deadly consequences.

“Nurses should not have to work in an environment where it is even possible to make that kind of mistake,” said Nancy Pratt, a senior vice president at Sharp HealthCare in San Diego who is a vocal advocate for changing the system. “The nuclear power and airline industries would never tolerate a situation where a simple misconnection could lead to a death.”

Some manufacturers have started using color codes to distinguish tubes for different functions -- but they've each used their own scheme, thus adding to the confusion! In 2008 California passed legislation mandating that different sorts of medical tubes not be compatible with each other, but the manufacturers’ trade association managed to push back implementation to 2013 and 2014.

Scientific American reports on research showing that a diet high in saturated fat causes the brain to become resistant to leptin and insulin, hormones that let us know when our need for food has been fulfilled.

The research in question was done on rats, and it's always tricky to extrapolate such work to humans; and there are serious ethical issues with killing rats to find our why humans become such pigs when they eat cows. But the phenomenon in question is expected to apply to humans as well.

The researchers also performed in vitro experiments where they directly observed palmitic acid (a common saturated fatty acid) inhibiting the signaling of nerve cells exposed to insulin.

On the other hand, oleic acid, a monounsaturated fatty acid, did not produce this result.

What evolutionary mechanism might produce such a result, that too much fat in the system actually tells the body to increase rather than decrease food uptake? Here's what one leptin expert quoted in the SciAm article says:

Science Daily reports on research by health economist Todd Elder that finds that up to close to a million children may be misdiagnosed with attention deficit hyperactivity disorder simply because they are the youngest (and therefore likely to be least mature) in their kindergarten class.

Turns out that the youngest kids in class are significantly more likely to be labeled ADHD and put on Ritalin or similar drugs -- wasting an estimated $320 to $500 million a year in unnecessary drugs. Great for big pharma, lousy for kids, parents, teachers, and anyone else who works with kids. (I've taught karate to a bunch of "ADHD" kids over the years. Some did indeed benefit from meds; but I would have to say that for at least half, the side effects of the pharmaceutical roulette that too often passes for mental health treatment these days was worse than the original problem.)

"If a child is behaving poorly, if he's inattentive, if he can't sit still, it may simply be because he's 5 and the other kids are 6," said Elder, assistant professor of economics. "There's a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD."

ADHD is the most commonly diagnosed behavioral disorder for kids in the United States, with at least 4.5 million diagnoses among children under age 18, according to the Centers for Disease Control and Prevention.

...

According to Elder's study, the youngest kindergartners were 60 percent more likely to be diagnosed with ADHD than the oldest children in the same grade. Similarly, when that group of classmates reached the fifth and eighth grades, the youngest were more than twice as likely to be prescribed stimulants.

Overall, the study found that about 20 percent -- or 900,000 -- of the 4.5 million children currently identified as having ADHD likely have been misdiagnosed.

This, of course, doesn't even touch on the kids whose "ADHD" is more accurately described as "Outdoor Exercise Deficit Disorder".

NPR reports on a survey of wild rapeseed (better known as "canola" for "Canadian Oil", since someone figured out that "rapeseed" was an ugly word, though it derivies from nothing more offensive than a Latin word for "turnip") that found hundreds of genetically modified plants growing along the sides of North Dakota roads.

According to ecologist Cindy Sagers, who led the study, "What we've demonstrated in this study is a large-scale escape of a genetically modified crop in the United States." Moreover, these aren't just plants sprouted from GMO seed that spilled, or blew over from a nearby field: evidence "indicates that these things are probably self-perpetuating outside of cultivation and have been there for a couple of generations at least," according to Sagers.

Pro-GMO researchers say there's nothing to worry about because these GMO canola plants won't out-compete wild plants. Which misses the point entirely: if GMO canola is in the wild, it's certainly in canola fields where supposedly non-GMO canola is being grown. Of course no one with a lick of sense who's considered the issue for more than thirty seconds would be surprised at that conclusion.

(For the roasting and sauteing that I do, I stick with organic extra virgin olive oil, and with coconut oil to grease my cast-iron skillet.)

Reuters is reporting on a study that claims to show that low-carb diets can have an advantage over low-fat ones for heart health. I'm sure that fans of Atkins-style diets, the folks who want to believe that bacon is a health food, will be touting the results. (If you actually read the article, you'll see that the small differences in HDL levels and blood pressure are no big deal, but I doubt that will stop low-carb fans from latching on to the headline.)

What this study actually shows, however, is just how utterly bad some nutrition research can be.

What was this "low-fat" diet like? The supposed low-fat diet had a target of 55 percent of calories from carbs, 15 percent from protein and 30 percent from fat.

But 30 percent of calories from fat is not a low-fat diet. The 30% recommendation was based on what was seen as an achievable goal in a fat-addicted culture, not as a health optimum; it's like, "hey, can you cut the cigarettes down to a pack a day?"

The average intake is estimated at 35.4% calories from fat in industrialized nations, so 30% is only a little below that. (I've seen estimates that the American average is 45%, but that only shows how fat-addicted we are, not that 30% is low.) In developing nations it's 19.6% -- close to the 20% estimated for Late Paleolithic humans. That's much higher than other primates, and almost certainly well in excess of our needs, but we might call 20% a moderate-fat diet. An actual low-fat diet like the Ornish plan gets around 10% of its calories from fat.

Considering 30% to be a "low-fat" diet is an all-too-common flaw in diet studies. But this one addds another big whopper. Where did the low fat, high carb diet get its carbs? Were those on this arm of the study getting complex carbs from vegetables and whole grains? Well, no: study participants

were instructed to start exercising regularly -- mostly brisk walking -- and learned tactics for weight management, such as writing down what they ate every day and setting reasonable short-term goals (if you normally eat 10 candy bars a week, for instance, first try cutting out a couple rather than going cold-turkey.)

(Emphasis added.) So it seems sugar was on the menu, even in high amounts.

Meanwhile, the low-carb group got their small ration of carbs from a strictly regimented selection of vegetables, fruits, grains, and dairy.

So the "low-fat" diet here was a high-fat, sugar-laden, nutritional nightmare, and the "low-carb" one was an even higher-fat, sugar-free nutritional nightmare. It's not surprising that the low-carb diet, bad as it is, might look good in comparison -- even with the side effects this study found common: hair loss, bad breath, and constipation.

And this passes for science?

A few days ago I stumbled upon a graph of the obesity rate in the U.S..
It was steadily slightly increasing since the 1960s and then around 1980 (the data points are too sparse to exactly locate the point), there was an inflection point where it started to climb more rapidly.

Now, look at this graph of U.S. consumption of sugars. HCFS gets introduced in the 1970s, it's cheap, and so we started to eat more sugar -- increasing our per-capita consumption about 20 pounds a year.

Notice the similarity in the shapes of the graphs. Hmm.

That 20 pounds works out to extra 25 grams of sugar a day, an extra 100 calories from sugar alone. So sugar itself is only a fraction of how many calories we over-eat -- our caloric intake increased about 25% between 1970 and 2000. But there's a pretty clear link -- put sugar in any food, and we'll eat more of it!

Correlation is not causation, as they say; but it does jump up and down and point and say, "Look here! Look here!"

I don't know how much of a role subtle biochemical effects involving fructose might or might not play a role on top of increased caloric consumption; the research seems mixed, though I've admittedly only scratched the surface. But the simple fact that food got sweeter, we started eating more of it, and got fat, explains a lot.

A study published earlier this year in the Archives of Internal Medicine looked at the effects of nut comsumption on blood cholesterol and triglyceride levels. The news is very good for those of us who are nuts for nuts: looking at data from 583 people in 25 trials conducted in 7 countries, the authors found "the best evidence yet that eating nuts reduces LDL cholesterol and improves the blood lipids profile," according to co-author Dr. Joan Sabaté, chair of the nutrition department at the Loma Linda University School of Public Health.

They found a dose-dependent effect where nuts lowered total cholesterol levels, improved the ratio of HDL (good) to LDL (bad) and total cholesterol, and reduced high triglyceride levels. The effect was the same for all types of nuts -- walnuts, almonds, peanuts (botanically, not a nut, but fakes it well enough), pecans, hazelnuts, macadamias and pistachios. They also found that the cholesterol lowering effect is greater then found when nuts replace saturated fats than when they replace olive oil or carbohydrates.

Now, there is such a thing as too much of a good thing: nuts are a great source of energy, as any trail-mix chomping hiker knows, so overdoing them can pack the diet with too many calories. The highest daily intake of nuts looked at in the trials reviewed was 132 grams -- 4.66 ounces, which is probably a little high. Sabaté recommends a limit of 3 ounces a day.

According to the FDA, "scientific evidence suggests but does not prove that eating 1.5 ounces of most nuts per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease."

As a snack, I love to cut up an apple or a pear and sprinkle on some almonds or walnuts. It's great raw, or sprinkle on some cinnamon and briefly bake, or heat it up in the microwave for a minute -- yum!

Surgeon General Regina Benjamin is announcing a new initiative to get Americans moving around:

That is why I am asking healthcare organizations across this country to join the Exercise is Medicine initiative. Exercise is Medicine is a multinational, multiorganizational initiative. It brings physical activity to the forefront of disease prevention and treatment, by making exercise a part of every patient's interaction with a health clinician. Exercise is Medicine strives to provide the essential connection between clinicians, fitness professionals, and the public, so that everyone can receive the guidance they need to stay healthy and active. All the partners in this initiative are dedicated to the idea that exercise is the new medicine. Partners are asked to continue to build, support, and advocate for physical activity as an essential element of global health and well-being by committing to action:

• Policy makers are asked to change policies to support physical activity as a major component of health.
• Clinicians and fitness professionals are asked to integrate exercise into every patient and client interaction.
• Communities, workplaces, and schools are asked to promote physical activity as an essential part of health and well-being.
• Members of the public are asked to educate and empower themselves to seek appropriate counseling on physical activity.

As health professionals, we should remember that patients are more likely to change their behavior if they have a meaningful reward -- something more than reaching a certain weight or dress size. The reward has to be something that each person can feel, enjoy, and celebrate. The reward is optimal health that allows people to embrace each day and live their lives to the fullest -- without disease, disability, or lost productivity. I hope you will join the Exercise is Medicine initiative. Together, America can become a Healthy and Fit Nation.

Since Benjamin is an Obama appointee, I expect we'll soon hear a backlash from the GOP's wacko wing about healthy people being some hidden Muslim socialist plot.

On the one hand, Benjamin has drawn fire for appearing to be overweight; on the other, she's a mountain climber who's training to take on Mount Kilimanjaro. As someone who's clearly "been there" in terms of dealing with excess weight, she might have the moral authority to get us off our fat butts and moving. One can only hope.

Following up on the topic of the endocrine disruptor bisphenol A (BPA), it seems that exposure from water bottles and other plastic food and beverage containers may be dwarfed by that caused by a surprising source: cash register receipts and other papers from thermal printers, and also carbonless copy papers. (Thanks Sean McCutcheon for the tip.)

These printing technologies rely on paper impregnated with zillions of microcapsules containing ink or dye; pressure or heat breaks the capsules and lets the ink out. (Fun fact: up until 1970, the dye was often made with polychlorinated biphenyls -- PCBs, delightfully toxic chemicals). In some methods, the paper has to be coated with a developer that reacts with the dye; that's where "phenolic resins" like BPA come in.