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August 2012


Walking reduces diabetes risk
High stress jobs raise heart risks
Low vitamin D increases mortality
Curcumin may prevent diabetes
Meat raises stroke risk
Music training protects aging brain

Walking reduces diabetes risk

Researchers evaluated 1826 subjects who were free of diabetes and cardiovascular disease at the start of their study. They followed them for five years and identified 243 cases of diabetes by the end of the study. They estimated the number of steps taken per day and divided the subjects into four groups (quartiles) based on the step count.

These subjects were not doing aerobic exercise or any formal exercise program, and all were obese at the start of the study and at risk for diabetes. By the end of the study period, those in the lowest quartile of physical activity had a significantly higher risk of developing diabetes, while those in the upper quartile had a 29 percent lower incidence. The subjects wore a pedometer to actually measure the number of steps per day. (Fretts AM, et al., Modest levels of physical activity are associated with a lower incidence of diabetes in a population with a high rate of obesity: the strong heart family study. Diabetes Care. 2012 Aug;35(8):1743-5.)

While physical activity and diabetes risk has been studied before, the number of steps has not been so carefully measured.  Those in the lowest quartile of physical activity did less than 3500 steps per day. The high level of activity was over 10,000 steps per day. This is not heavy exercise because the number of steps does not account for speed, and these groups were simply moving during the course of normal activity, not exercising for fitness.

High stress jobs raise heart risks

Stress comes in many forms, and many life activities are sources of stress. Work related stress is common, and new research shows that job stress increases the risk of cardiovascular disease (CVD). Investigators examined the relationship between job strain, job insecurity, and CVD over 10 years of follow-up of 22,086 participants in the Women’s Health Study. (Slopen N, et al., Job strain, job insecurity, and incident cardiovascular disease in the Women's Health Study: Results from a 10-year prospective study. PLoS One. 2012;7(7):e40512. Epub 2012 Jul 18.)

At the start of the study, the average age of participants was 57 years. During the 10 years of the study, the participants had 170 myocardial infarctions (heart attacks), 163 ischemic strokes, 440 coronary surgeries, and 52 cardiovascular deaths. Work stress and job insecurity were evaluated with questionnaires.

Women with high job stress (those with lots of demands on their skills and time, but little control) had a 38 percent higher incidence of CVD than those reporting lower stress. Specific increases were seen for non-fatal heart attacks (with a 67 percent increased risk) and for coronary surgery (with a 41 percent increased risk). Giving workers more decision-making responsibility helps to reduce work-related stress and its complications. However, even with responsibility and control, stressful jobs lead to heart problems.

This is probably also true for men, but they were not part of this study. The data in the study do not prove a cause and effect relationship, just a correlation of psychological demands and lack of control with CVD. Job insecurity, contrasted with other job stress, was not directly related to CVD, but it was related to increased CVD risk factors (such as hypertension, high cholesterol, and depression/anxiety).

Low vitamin D increases mortality

Low vitamin D levels and frailty have both been related to an increased risk of mortality. A new study looked at the combined effects of these two risk factors. Frailty was defined by low body mass index (BMI), slow walking, weakness, exhaustion, and low levels of physical activity; meeting two of these criteria was defined as “pre-frailty” and meeting three or more as frailty.

Vitamin D status was assessed by testing serum levels of 25(OH) vitamin D. Those subjects in the lowest quartile of vitamin D levels were almost twice as likely to be frail as those in the highest quartile. Quartiles of vitamin D were defined as less than 20 ng/ml, 20 to 26 ng/ml, 26 to 34 ng/ml, and greater than 34 ng//ml. (Smit E, et al., The effect of vitamin D and frailty on mortality among non-institutionalized US older adults. Eur J Clin Nutr. 2012 Jun 13. doi: 10.1038/ejcn.2012.67.) The 4731 subjects were 60 years old at the start of the study, and they were followed for 12 years.

The frailty associated with low vitamin D correlated with an increased mortality from all causes. The highest risk was among those subjects with both frailty and the lowest levels of vitamin D. Their risk of mortality was three times higher than those without frailty and with the highest levels of vitamin D. Optimal levels of 25(OH) vitamin D are higher than 34 ng/ml. Among vitamin D researchers, many consider the ideal to be between 60 and 100 ng/ml. In most latitudes, this is difficult to achieve without supplements, especially in winter.

Avoiding frailty is achieved partly through exercise, including both walking, running, or aerobic-type activity, and some form of resistance training, such as using weights or elastic exercise bands, or calisthenics (push-ups, sit-ups, etc.). It also requires eating a healthy diet and maintaining normal body mass index. Inadequate calorie intake is not usually a problem in the U.S., but it is often a problem in the elderly.

Curcumin may prevent diabetes

Curcumin is a derivative of turmeric, a common spice in South Asia and a standard component of curry powders. It has numerous healthful properties. Consumption of curcumin is associated with a decreased incidence of Alzheimer’s disease, and it has anti-inflammatory and anti-platelet effects. A new study shows that it can also help prevent diabetes.

In a double-blind, placebo-controlled trial with 240 subjects with pre-diabetes, researchers gave either curcumin or placebo capsules for nine months. They assessed the progression of their condition to diabetes and also did other testing. This included changes in beta-cell function (the cells that produce insulin), insulin resistance, C-peptide levels, and anti-inflammatory cytokines. (Chuengsamarn S, et al., Curcumin extract for prevention of type 2 diabetes. Diabetes Care. 2012 Jul 6. [Epub ahead of print])

After nine months, 16.4 percent of the placebo group were diagnosed with diabetes, while none of the curcumin treatment group developed the disease. The curcumin group also had lower insulin resistance, better beta-cell function, and lower C-peptide levels. Curcumin is one of many natural treatments for diabetes and its prevention. These include high-fiber diets and exercise, and supplements of chromium, alpha-lipoic acid, cinnamon, milk thistle (with standardized amounts of silymarin), and coenzyme Q10.

Meat raises stroke risk

Meat consumption has been associated with an increased risk of numerous health problems, such as heart disease, cancer, hypertension, strokes, and others. Although prospective studies have provided various and inconsistent results, the weight of the evidence is a quite clear indictment of eating meat. A new report is a meta-analysis (study of studies) summarizing the results of six prospective studies on meat consumption and the risk of strokes.

These six studies included 329,495 participants. Their diet analysis included fresh, processed, and total red meat consumption. Among these subjects, they found 10,630 cases of stroke. The risk of ischemic stroke, but not hemorrhagic stroke, was 12 to 15 percent higher for each serving per day of meat. Processed meat was the worst of the lot. (Kaluza J, et al., Red meat consumption and risk of stroke: a meta-analysis of prospective studies. Stroke. 2012 Jul 31. [Epub ahead of print]

It is not surprising that it was only ischemic stroke that was affected. Saturated fats from meats increase blood clotting and are associated with an increase in atherosclerosis, both of which raise the risk of ischemic damage. The meats in this review included beef, pork, lamb, ham, hot dogs, sausage, and bacon. These are not necessary in the diet, and it is better to replace them with fish, beans, whole grains, seeds, nuts, vegetables, and fruits.

Music training protects aging brain

Musical instrumental training provides personal and aesthetic pleasure, and it is particularly valuable as we age. Some research has shown that playing music for more than 10 years can improve the function of the aging brain. However, it was not clear in these reports whether the subjects who engaged in musical training were also more physically active in general, which could have accounted for the observed benefits.

A new study attempted to account for these ambiguities by controlling for general activity level. They analyzed 70 age- and education-matched older musicians (more than 10 years of playing) and non-musicians with neuropsychological tests. All of the subjects were 59 to 80 years old, and they did not differ in their general lifestyle activities. (Hanna-Pladdy B, Gajewski B, Recent and past musical activity predicts cognitive aging variability: direct comparison with general lifestyle activities. Front Hum Neurosci. 2012;6:198. Epub 2012 Jul 19.)

Musicians scored higher on a number of tests, including verbal working memory, immediate recall, visuospatial judgment, and motor dexterity, as well as phonemic fluency (the ability to generate words that start with particular letters). These enhanced cognitive functions were independent of other general leisure activities. An early age of acquisition of musical training was an advantage, but even learning later in life, if sustained for over 10 years, was helpful in maintaining cognitive functions.

Music training changes and strengthens the brain because it is such a complex activity, and it demands a range of auditory processing, motor skills, and memory. The authors also noted that education levels enhanced some cognitive functions, but recent musical engagement offset the effects of low education. Other studies have suggested that learning a musical instrument at an older age challenges the brain and enhances cognitive function. (The neurologist, Oliver Sacks, has demonstrated remarkable awakening of Alzheimer’s patients when singing along with recorded music.) I am lucky to have been playing early music on recorder for over 40 years, starting when I was an adult. (Now, go practice your violin! or recorder, piano, flute, guitar, or clarinet, or perhaps you like the ukulele.)

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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
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

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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.