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August 2011

Fiber lowers breast cancer risk
Arthritis increases heart risk
Peri-natal vitamins lower premie risk
Exercise – almost any lowers heart risk
Meats raise diabetes risk
Prenatal omega-3 lowers kids’ colds

Fiber lowers breast cancer risk

Consuming high amounts of dietary fiber has many benefits, including lowered risk of heart disease and diabetes, and reduced rates of colon cancer. A new review of studies shows that higher fiber intakes also lower the risk of breast cancer. Researchers evaluated 10 prospective studies involving a total of 712,195 participants.

They found that those subjects with the highest fiber intake had about 11 percent less risk of breast cancer than those with the lowest intake. The studies followed participants for 7 to 18 years, during which time 16,848 cases of breast cancer occurred. (Dong JY, et al., Dietary fiber intake and risk of breast cancer: a meta-analysis of prospective cohort studies. Am J Clin Nutr. 2011 Sep;94(3):900-5.)

While the total risk reduction was relatively small, they did calculate that for every 10-gram (1/3 ounce) increase of fiber intake the risk was reduced by 7 percent. Because typical fiber intake is a very low 10 to 15 grams, the room for improvement is great. Raising fiber intake with whole grains, vegetables, beans, fruits, seeds and nuts can have a significant benefit in lowering risk by up to 50 percent, if enough fiber is consumed, according to this meta-analysis. Animal products do not contain fiber.

In this analysis, the benefits are not proven to be from the fiber itself. The participants might have had other healthy lifestyle choices that were not accounted for, or it may be that foods that are high in fiber are also high in many other nutrients that lower cancer risk (vitamins, minerals, antioxidants and phytochemicals). Higher fiber diets are associated with lower estrogen levels, and estrogen is a risk factor for breast cancer. (The native African diet that Denis Burkitt studied in the 1950s contained about 100 grams of fiber from their dietary staples – potatoes, bananas, corn meal, and beans.)

Arthritis increases heart risk

Rheumatoid arthritis is an auto-immune disorder with chronic inflammation of the joints. The inflammation has widespread effects independent of the joints, including the increased risk of developing heart disease. Researchers in Sweden used a predictive model to evaluate the influence of chronic rheumatoid arthritis on future cardiovascular morbidity and mortality.

From 1995 until 2008, they collected clinical records on 700 patients, and at the end of that time, 442 patients had reached the predetermined 5-year follow-up period. During those five years, treatment for hypertension increased from 24.5 to 37.4 percent. The diagnosis of diabetes increased from 7.1 to 9.5 percent. A total of 23 patients died during the follow-up period, including 12 fatal cardiovascular events. (Innala L, et al., Cardiovascular events in early rheumatoid arthritis (RA) are a result of inflammatory burden and traditional risk factors: a five year prospective study. Arthritis Res Ther. 2011 Aug 15;13(4):R131. [Epub ahead of print])

Drugs that modify the disease process, rather than just treating the symptoms seem to reduce the heart risks. However, these drugs, such as methotrexate can have their own serious side effects. The use of COX-2 anti-inflammatory drugs appeared to increase the risk. These include such common treatments as Celebrex and Vioxx, but not the older anti-inflammatory drugs such as aspirin and ibuprofen. The higher heart risks were found in spite of the helpful lifestyle modifications that the patients made, such as quitting smoking and losing weight.

Non-drug treatments might be very beneficial for prevention of these heart risks, as they reduce inflammation without side effects. These include vitamin C, omega-3 fish oils, curcumin, ginger, and boswellia. Diet also makes a difference, as arachidonic acid, a non-essential fatty acid found in animal fat, increases inflammation. A study from 2003 showed that a diet low in arachidonic acid (which is mostly a vegetarian diet) enhanced the beneficial anti-inflammatory effects of dietary fish oil. (Adam O, et al., Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int. 2003 Jan;23(1):27-36.)

Peri-natal vitamins lower premie risk

Babies born prematurely or who are small for their gestational age have many more health complications and higher infant mortality than full-term, normal-weight infants. Maternal health habits influence the likelihood of prematurity. Taking dietary supplements before conception and early in pregnancy can decrease the chance that an infant will be born either prematurely or of low birth weight.

In a Danish study of 35,897 births, researchers asked the number of weeks of multivitamin use during the 12-week period surrounding conception. They also asked whether the supplements were taken before or after conception or both, and how frequently they were taken. (Catov JM, et al., Periconceptional multivitamin use and risk of preterm or small-for-gestational-age births in the Danish National Birth Cohort. Am J Clin Nutr. 2011 Sep;94(3):906-12.)

Regular pre- and post-conceptional consumption of multivitamins in women with normal weight (body mass index, or BMI, of less than 25 led to a 16 percent lower risk of pre-term birth. For overweight women, there was no such association.

The incidence of “small for gestational age” infants was reduced by 17 percent in both normal and overweight women. This association was strongest for women who took supplements consistently in the period just following conception. Pre- and post-conceptional dietary supplements have a number of other benefits also, including the reduced incidence of birth defects, particularly from taking folic acid as part of the supplement program. Folic acid is a typical component of prenatal vitamins.

Exercise – almost any lowers heart risk

It is not news that exercise lowers mortality and the incidence of specific chronic diseases, such as heart disease, diabetes, hypertension, and stroke. The usual recommendation is an average of 150 minutes of exercise per week. However, it is possible that less exercise might also offer some benefits, and this is analyzed in a recent study from Taiwan.

Researchers followed 416,175 men and women from 1996 to 2008, with an average follow-up of 8 years. Based on a questionnaire, participants were placed in one of five categories of exercise quantity per week, from the lowest (inactive) through low, medium high or very high levels. With the inactive group as the baseline, they calculated the risks of mortality and the life expectancy of the other groups. (Wen CP, et al., Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011 Aug 14. [Epub ahead of print])

Those who exercised 92 minutes per week (about 15 minutes per day on average) had a 14 percent reduction in all-cause mortality and a 3-year longer life expectancy than the inactive group. Each additional 15-minutes of daily exercise further reduced the all-cause mortality by four percent.

It was surprising that even the smallest amount of exercise had a significant benefit on heart and cancer mortality and life expectancy. It seems that for the sedentary person, the concept of exercise engenders visions of marathon training, and this is enough to put them off from any further thoughts of starting. However, at any level of fitness (or lack of fitness), it is possible to engage in some level of activity. The key to aerobic exercise is that one never gets out of breath. As fitness progresses, the intensity of the exercise one can do increases with the same perceived effort and still within the breath capacity.

Meats raise diabetes risk

The research on the dangers of red meat consumption continues to accumulate. A new article relates meat consumption, and especially processed meats, to an increased risk of diabetes. In the Health Professional Follow-up Study of 37,083 men, the Nurses’ Health Study I of 79,570 women, and the Nurses’ Health Study II of 87,504 women, diet was assessed by validated food-frequency questionnaires, and updated every 4 years.

Overall, during 4,033,322 person-years of follow-up researchers documented 13,759 cases of type 2 diabetes (T2D). They then accounted for age, body mass index, lifestyle, and other dietary factors. They found that for each serving per day of unprocessed meat the risk of T2D went up by 12 percent. For processed meat, the increased risk was 32 percent, and for combined processed and unprocessed total meat consumption the risk per serving increased by 14 percent.

These findings were confirmed by a meta-analysis of 442,101 participants with 28,228 cases of T2D. In that analysis, 100 grams of unprocessed meat led to a 19 percent increase in the risk of T2D (100 grams is about 3 ounces, which is less than most restaurant portions). For processed meats, a mere 50 grams led to a 51 percent increase in T2D risk. The researchers estimated, based on the data, that substitutions of one serving of nuts, low-fat dairy, or whole grains for red meat were associated with a 16 to 35 percent lower risk of diabetes. (Pan A, et al., Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. Am J Clin Nutr. 2011 Aug 10. [Epub ahead of print])

Prenatal omega-3 lowers kids’ colds

Women who take prenatal omega-3 oils have healthier children. DHA (docosahexaenoic acid) is one of the two omega-3 oils found in fish (the other is EPA, or eicosapentaenoic acid). (Flax seeds and walnuts contain alpha-linolenic acid, which is converted, with variable efficiency, to EPA and DHA.) Omega-3 supplements usually contain 30, 50, or 60 percent of EPA and DHA combined, of which 12, 20, or 24 percent is the DHA component.

In this double blind, randomized, controlled trial, pregnant women were given 400 mg of DHA or placebo from 18 to 22 weeks gestation through childbirth and then the children were evaluated for symptoms of respiratory infections at 1, 3, and 6 months after delivery. (Imhoff-Kunsch B, et al., Prenatal docosahexaenoic acid supplementation and infant morbidity: Randomized controlled trial. Pediatrics. 2011 Aug 1. [Epub ahead of print])

Those infants of mothers taking DHA had fewer colds at one month, and 15 to 54 percent fewer symptoms and days of illness at the various stages of the study. It is possible that maternal supplementation led to stronger immune systems prior to delivery or that alterations in the mothers’ milk helped the infants after birth.

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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
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Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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