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September 2012

Topics:

Dr. Ornish editorial on diets
Plavix, aspirin, and stroke risk
Lead and gout
Healthy living lengthens life
Pan-fried meat tied to cancer risk

Dr. Ornish editorial on diets

Dean Ornish, MD, has been a lead researcher in diet and heart disease (as well as other diseases) for decades. He first published an article that showed reversal of coronary artery disease with a combination of mild exercise, stress management, and a low-fat, mostly vegetarian diet. He has now published an opinion piece in the New York Times titled Eating for Health, Not Weight (September 22, 2012). You can view the whole article at this link: http://www.nytimes.com/2012/09/23/opinion/sunday/the-optimal-diet.htm

He points out that losing weight on a diet (which people almost always do just before they put it back on again, and again) is no guarantee of better health, depending on the dietary choices they make to lose the weight. Followers of the high-protein, low-carbohydrate programs that are the subjects of many books and advertising programs are unlikely to improve their long-term health. Their diets are usually heavily weighted with meat and cheese, and short on high-fiber whole grains and legumes. (I think that every camp agrees that refined carbs, such as sugar, white flour, white rice, and corn syrup, are harmful.) As Ornish notes, “never underestimate the power of telling people what they want to hear…”

As a result, they are ignoring a large body of evidence showing that consuming higher amounts of meat and other animal products, except fish, leads to more heart disease, cancer, elevated inflammatory markers, and diabetes. Critics of these conclusions frequently point out that of all of the studies showing harm from meat consumption, none of them studied “grass-fed” meat. This is true, because so few people consume it (and it is relatively difficult to get, especially if you eat at restaurants).

Meats from grass-fed animals may well be healthier, but we do not know that. Until there are large scale studies on people whose only meat is from grass-fed sources, we are unlikely to be able to draw any conclusion that it leads to lowered rates of any disease. It may be that it is just as harmful as other meats, but I’d rather not be the guinea pig who proves the point. Until there is such convincing data, the belief that the high-protein, low-carb approach could be healthier than a whole, natural, plant-based diet is not supported by science.

Plavix, aspirin, and stroke risk

After a stroke due to cerebral vascular disease, patients are often put on a combination of Plavix (clopidogrel) and aspirin in the hope of preventing another stroke. These drugs both reduce the adhesiveness of platelets so that they do not clump as easily and clog compromised arteries. The side effects of these drugs include an increased risk of bleeding. Researchers studied patients with “lacunar infarcts,” small strokes deep in the brain that are the result of long-term high blood pressure.

They studied 3020 patients averaging 63 years old, all of whom were given 325 mg of aspirin daily (one adult aspirin pill). In addition, half the patients were given 75 mg of clopidogrel and half a placebo. They followed the subjects for a mean of 3.4 years and evaluated the incidence of recurrent strokes from vascular obstruction (ischemic strokes) or hemorrhage (usually the result of the drugs themselves). They also evaluated the overall mortality from all causes.

They found that the risk of recurrent stroke was not significantly lower in the group receiving the dual antiplatelet therapy compared to those on aspirin alone (2.5 percent compared to 2.7 percent). In those patients on dual therapy, the risk of major hemorrhage was doubled compared to those on aspirin alone. In addition, all-cause mortality was higher in the dual therapy group (113 deaths) than in the aspirin-only group (77 deaths). (Benavente OR et al., Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012 Aug 30;367(9):817-25.)

In some circumstances, dual therapy is initiated to prevent closure of stents after angioplasty, with the benefits mostly in the first three months, although patients are often kept on these drugs for a year or longer. Many dietary supplements have anti-platelet effects, although usually not as strong as the drugs, and some combination of these nutrients may well be a good substitute for the drugs, but we do not have enough data on them. These include fish oil omega-3 fatty acids, flaxseed oil, vitamin E, bilberry, garlic, ginger, ginkgo biloba, curcumin, and resveratrol (grape/wine extract), among others.

Lead and gout

Lead is a known toxic heavy metal that is difficult to avoid in the environment. It comes from contaminated soil, old house paint, artists’ paint, old lead pipes, and some industrial exposure (for example, battery workers). The levels that are considered toxic used to be set at a much higher amount in the blood than is acceptable now. However, even these new low levels are apparently not safe. Although blood lead levels in the United States now average much less than when leaded gasoline was in common use, people are still exposed from other sources.

Lead is considered safe in adults if the blood level is below 25 mcg per deciliter (dl, or 100 ml). The old “safe” level was under 100 mcg/dl. For children the safe level is much lower, as they are more susceptible to the effects of lead on the developing brain. Their “safe” blood level is now under 10 mcg/dl, but even lower levels have been associated with poorer cerebral function.

Adults now average about 3 mcg/dl in the United States, considered to be well below harmful levels. New research suggests that we should not be complacent even about these levels. In an observational study of 6153 subjects, gout was found in six percent of the population. (Krishnan E, et al., Low-level lead exposure and the prevalence of gout: an observational study. Ann Intern Med. 2012 Aug 21;157(4):233-41.)

Gout is an arthritic condition resulting from deposits of uric acid in the joints (it can also deposit in the kidneys causing kidney stones). It can be extremely painful. Uric acid levels are increased by alcohol, red meat, organ meat, shellfish, and sugary foods—especially the high-fructose corn syrup found in sodas.

After adjusting for many variables, those patients with the highest blood lead levels had a risk of gout that was 3.6 fold higher than in those with the lowest levels. Subjects in the lowest quartile of blood led had only 0.89 mcg/dl. Those subjects in the “highest” quartile of blood lead averaged less than 4 mcg/dl, but even with this relatively low level they still had more gout.

Considering the difficulty of achieving the lowest levels of blood lead, it may be wise to take supplements that lower lead. One of these is dimercapto succinic acid, or DMSA. Typically, use of only 100 mg per day over a month or two will significantly lower lead levels (as well as arsenic). Lead can also be removed with intravenous chelation therapy with EDTA (ethylene diamine tetraacetic acid), but that needs to be done at a medical office.

Healthy living lengthens life

It should perhaps come as no surprise that healthy living can prolong life, but it is difficult to do longevity studies in humans, so it is an important piece of information when we find research that confirms this. In a study of 1810 Swedish adults over 75 years old, followed for 18 years, the median age at death was the main outcome that was measured. During the length of the study, 1661 of the participants died.

Half of the participants lived to more than 90 years old. Smokers died a year earlier than non-smokers on average. Physical activity was the most beneficial lifestyle habit associated with survival. Those who regularly walked, swam, or did gymnastics achieved an average of two years extra longevity. The average survival of people with a low risk profile (non-smokers who were physically active, had good diets, and had a good social network) was 5.4 years greater than for those with none of these healthy lifestyles. (Rizzuto D, et al., Lifestyle, social factors, and survival after age 75: population based study. BMJ. 2012 Aug 29;345:e5568. doi: 10.1136/bmj.e5568.)

This may not seem like a lot over a lifetime, but when you consider that these people already made it to 75, the numbers are quite significant over the relatively brief 18 years of the study. The authors concluded that the low risk profile could add five years to women’s lives and six years to men’s. Such an average improvement in health would go a long way to solving the health care crisis, because not only do they live longer, they have fewer ailments.

Pan-fried meat tied to cancer risk

Yet another study shows the potential damage to health from eating red meat. At the risk of alienating people who don't believe in the dangers of meat (primarily those in the meat industry), I report on the data as I find it. This study, reported by the University of Southern California and the Cancer Prevention Institute of California, focuses on the cooking method. Pan-frying exposes the surface of the meat to very high temperatures, triggering the release of cancer-causing chemicals. This is the way hamburgers are cooked, and being relatively thin the heat permeates into the center of the meat.

Earlier studies on meat and prostate cancer showed a relationship, but they were not consistent, possibly because they did not examine the cooking method. In this study, researchers examined pooled data from nearly 2,000 men who were part of a prostate cancer study. They evaluated the kind of meat consumed, the processing, and the cooking method, including the level of doneness based on color photographs. More than 1000 of the men included in the study were diagnosed with advanced prostate cancer. (USC Media News Release, August 15, 2012 Pan-fried meat increases risk of prostate cancer. www.usc.edu/uscnews/newsroom/news_release.php?id=2785)

Men who ate more than 1.5 servings of pan-fried meat per week had a 30 percent higher risk of advanced prostate cancer. Those men who had more than 2.5 servings per week had a 40 percent increased risk. The reasons for this finding are not clear, but it could be due to the heterocyclic amines (HCA) produced during high-temperature cooking of meat (and poultry). Grilling or smoking produces other carcinogens, such as polycyclic aromatic hydrocarbons (PAH).

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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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