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August 2013

Topics:

Nutrients reduce pancreatic cancer
Red meat increases diabetes risk
Supplements shorten hospital stays
Low vitamin D leads to aging bone
Serum antioxidants and mortality
[Practical guidelines are now included at the end of each article]

Nutrients reduce pancreatic cancer

A number of news articles have appeared over the past few years suggesting that dietary supplements offered no benefit to health, and might even increase some disease rates and mortality. These have been based on studies that are often misleading. The reviews usually include the articles that show that beta-carotene can increase the risk of lung cancer in smokers, and this one effect skews the overall results. The overall weight of the evidence over many years suggests that a diet rich in nutrients, as well as dietary supplements, can reduce the risks for many diseases and degenerative conditions, and also reduce the length of time patients have to stay in hospitals, and mortality.

A recent study shows that nutrients from food and supplements, primarily those found in fruits and vegetables, can reduce the risk of pancreatic cancer. The study included 384 cases and 983 matched controls. The participants completed food-frequency questionnaires, including supplements, and the results were adjusted for confounding variables, such as age, sex, smoking, body mass index, energy intake, and alcohol consumption. (Jansen RJ, et al., Nutrients from fruit and vegetable consumption reduce the risk of pancreatic cancer. J Gastrointest Cancer. 2013 Jun;44(2):152-61. doi: 10.1007/s12029-012-9441-y.)

The researchers evaluated the subjects for intake of magnesium, potassium, selenium, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, zeaxanthin, niacin, total alpha-tocopherol, total vitamin A activity, vitamin B6, and vitamin C. The results showed a significant reduction in pancreatic cancer risk associated with increasing consumption of all of these nutrients from both diet and supplements. Most of the supplements investigated were significantly associated with a decreased risk of pancreatic cancer, including beta-carotene, niacin (B3), thiamin (B1), vitamin A, and pyridoxine (B6).

Practical guidelines:

It is best to get as many of these nutrients as possible from a diet rich in healthy fruits and vegetables that are minimally processed, but is also helpful to take supplements of those that are sometimes depleted due to farming practices, shipping, storage, processing, and cooking. Also, some studies show that people with the highest serum levels of many nutrients have the best protection from cancer and heart disease, among other conditions. In population studies, those groups with the highest serum levels include those subjects who are eating well and taking supplements.

Red meat increases diabetes risk

Many people try to avoid refined carbohydrates (sugar, white flour, and white rice, for examples) to minimize the risk of diabetes, but news articles and even health newsletters fail to make the distinction between refined carbohydrates and complex carbohydrates, such as whole grains, legumes, and starchy vegetables. Much research has clearly shown that complex carbohydrates actually reduce the risk of diabetes and insulin resistance. The early studies by Denis Burkett, MD, in Africa showed that their diet staples (potatoes, bananas, corn meal, and beans) were associated with a very low risk of diabetes, heart disease, hypertension, stroke, colon cancer, varicose veins, and hemorrhoids. This was a diet that consisted of about 80 percent carbohydrates, mostly complex.

On the other hand, proponents of meat-based diets fail to point out that meat consumption is associated with higher risks of many of the preventable diseases listed above, and recent research shows that increasing dietary meat leads to more type 2 diabetes. Researchers followed 26,357 men in the Health Professionals Follow-up Study, 48,709 women in the Nurses’ Health Study, and 74,077 women in the Nurses’ Health Study II. The studies took place from 1986 to 2007. They used food frequency questionnaires at the start of the studies and updated them every four years. They also adjusted for age, family history, race, marital status, initial red meat consumption, smoking status, and initial and changes in other lifestyle factors (physical activity, alcohol intake, total energy intake, and diet quality). (Pan A, et al., Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women. JAMA Intern Med. 2013 Jul 22;173(14):1328-35.)

Over 1,965,824 person-years of follow-up, there were 7540 cases of new-onset diabetes. Over any 4-year period, increasing red meat consumption led to an elevated risk of diabetes during the subsequent 4 years in all three studies. Overall, increasing red meat consumption of a half serving per day (an example of a half serving is just 1.5 ounces of hamburger) led to a 48 percent elevated risk of diabetes. Reducing red meat consumption during any 4-year period led to a 14 percent lower risk during the entire follow-up period through 2007.

Practical guidelines:

I think it is fairly obvious from this and many of the studies that I have reported on previously that it is a good idea to reduce or eliminate meat consumption. If one problem is the fat in the meat (which is only part of the problem) it will not be of benefit to replace the meat with cheese, which is even higher in fat. Only part of the problem is the increased weight associated with increasing meat consumption. Replacing meat with legumes, and whole grains, is a smart idea. Many vegetables have a surprisingly high protein content (a medium zucchini has 2.5 grams of protein, and a serving of broccoli has nearly 5 grams of protein).

Supplements shorten hospital stays

Although the value of dietary supplements has been belittled in the press and by some researchers, evidence suggests that they could have a great benefit for both healthy and sick people. Researchers did a retrospective study on oral nutritional supplements (ONS) in hospital patients over 11 years. The database they analyzed had information on 44 million adult hospital admissions.

They used matched samples for any inpatient diagnosis and compared those who received ONS while hospitalized with those who did not. They then looked at the effect of supplements on length of hospital stay, overall cost for the stay, and probability of readmission within 30 days. (Philipson TJ, et al., Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care. 2013 Feb;19(2):121-8.)

Interestingly, in only 1.6 percent of the 44 million admissions included ONS, but because of the total size of their sample, this meant 1.2 million admissions where patients were administered oral nutritional supplements, enough for meaningful statistical analysis. On average, those who received ONS had a shorter stay in the hospital by 2.3 days, a 21 percent decline. They also had a decreased hospitalization cost by $4734, a 21.6 percent decline. ONS patients also had a 2.3 percent reduction in the likelihood of readmission to the hospital within 30 days. We don’t know if higher doses of the supplements might have further improved these benefits.

Practical guidelines:

It is always best to stay out of the hospital as much as possible, but if you need to be an inpatient, the sooner you get out the better. You are then less likely to get a hospital-acquired infection, less likely to be the victim of a medical error, and less likely to be harmed by inadequate hospital food. It is unfortunate that so few of these patients received nutritional supplements. Discuss this with your doctor before any necessary hospital admission to see if oral nutritional supplements can be ordered.

Low vitamin D leads to aging bone

Vitamin D deficiency is widespread, and it plays a role in a number of medical conditions. Perhaps the best known is bone health. In the absence of adequate vitamin D, mineralization of bone is defective, but that is not the only contributor to bone strength. The entire composition of the bone, from the nano- to the micro-structure, influences the resistance to fracture, and vitamin D deficiency may be related to numerous pathological pathways.

Osteoid is the collagenous matrix of bone that needs to be mineralized for it to become strong, well-formed bone. Researchers have found that excess osteoid formation, seen with vitamin D deficiency, hampers production of strong, healthy bone. (Busse B, et al., Vitamin D deficiency induces early signs of aging in human bone, increasing the risk of fracture. Sci Transl Med. 2013 Jul 10;5(193):193ra88. doi: 10.1126/scitranslmed.3006286.) Using various sophisticated techniques, they were able to evaluate several indicators of bone aging aside from osteoporosis.

Their techniques revealed the aged nature of even well-mineralized bone and its decreased fracture resistance with vitamin D deficiency. The reported deficiency levels were below 20 nanograms/mL.

Practical guidelines:

It is a good idea for most people to take vitamin D supplements for many of the benefits that I have reported previously. It is best to have a blood test done to see what your level is and try to keep it above 40 to 60 nanograms/mL. It is difficult to get adequate serum levels without supplements because the sun is a variable contributor to vitamin D production, and most foods have very little. For bone health, it is also important to get impact exercise, such as walking, jogging, tennis, skipping rope, and others.

Serum antioxidants and mortality

A new study evaluates the relationship between serum antioxidants and the risk of mortality from cancer, heart disease, and all causes. The authors reviewed data from the third National Health and Nutrition Examination Survey (NHANES III). They evaluated the serum levels of vitamins C and E, beta-carotene, and selenium, and vitamin A levels. (Goyal A, et al., Serum antioxidant nutrients, vitamin A, and mortality in US adults. Cancer Epidemiol Biomarkers Prev. 2013 Aug 8. [Epub ahead of print])

Over a follow-up period of 14.2 years there were 4225 deaths, including 891 from cancer and 1,891 [not a typo; ed.] from cardiovascular disease. They divided the nutrient levels into quintiles, with Q1 being the lowest level and Q5 the highest. For vitamin C, the highest intake was associated with the lowest cancer and overall mortality risks. For vitamin A, the risk went down from Q1 to Q2, but higher levels offered no further protection.

For vitamin E, Q4 levels were associated with the lowest cancer mortality risk. For beta-carotene, cancer mortality risk declined from Q1 to Q2, and for selenium the decline was seen from Q1 to Q4. These data suggest that the supplements were beneficial in reducing mortality, but that you don’t need the highest levels to get the full benefits except for vitamin C, but that the highest levels do not create increased risks.

Practical guidelines:

Antioxidant supplements provide protection from mortality from cancer and heart disease. A good all natural multivitamin would provide a reasonable benefit, but it might be of even more benefit to add some extra vitamins C and E. If you take vitamin E supplements, it is best to find one that contains a reasonably large amount of gamma-tocopherol to balance the usual alpha. Be sure to get natural vitamin E, which includes the prefix “d-alpha” as opposed to the synthetic prefix of “dl-alpha.” For selenium, a supplement of 100 to 200 mcg is commonly available.

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CONSULTATIONS:

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.

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