NSAIDS and stroke mortality
Vitamins to lower stroke risk
Magnesium helpful for diabetics
Whole grains lower mortality risk
Nutrients lower pancreatic cancer risk
Some of the more recently developed, selective non-steroidal anti-inflammatory drugs (NSAID) are associated with an increased risk of stroke mortality. These newer drugs include diclofenac (Voltaren®) and etodolac (Lodine®). Older drugs, such as aspirin and ibuprofen, were not associated with this risk. The drugs are commonly used to treat both osteoarthritis and rheumatoid arthritis. They reduce both pain and inflammation.
A new study from Denmark reveals some of these risks. Researchers used medical databases to conduct a nationwide population-based study. Between 2004 and 2012, they identified first-time stroke hospitalizations and subsequent mortality. They evaluated the records of 100,043 patients and categorized them as NSAID users if they had filled a prescription within 60 days before hospital admission, or as non-users or former users. Current use was further categorized as new or long-term use. They then examined how many patients died within 30 days of admission.
They found that the overall mortality for ischemic stroke patients who were current users was 19 percent higher than for non-users. Most of that effect was due to the 42 percent higher risk among new users. This was due to a 53 percent increase for Lodine® and 28 percent increase for Voltaren®. Former users had no increased risk of stroke. Use of nonselective, older NSAIDs (such as ibuprofen – Motrin® or Advil®) was not associated with increased stroke risk. (Schmidt M, et al., Preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs and 30-day stroke mortality. Neurology 2014 Nov 25;83(22):2013-22.)
New medications are sometimes clearly better than older medications and sometimes they are not. In evaluating the benefits for pain relief and anti-inflammatory effects, aspirin or ibuprofen might do the job without increasing other risks (although they may be associated with gastrointestinal bleeding). In some studies, arthritis pain relief and swelling reduction can be achieved with non-drug treatments, such as fish oil, vitamin C, curcumin, ginger, boswellia, vitamin E, and bromelain (a pineapple-derived enzyme).
The vitamin E doses needed to treat rheumatoid arthritis were 1200 IU to 1800 IU daily. The fish oil dose is typically 3000 mg of EPA plus DHA. The bromelain dose is typically 3000 mcu three times per day (mcu is milk clotting units). I routinely take vitamins C and E, as well as curcumin and add boswellia and fish oil as needed for injuries, and sometimes bromelain.
Of course, if you can avoid a stroke altogether then the risk of stroke mortality from medications is less important. One way to avoid strokes is to lead a healthful lifestyle. This means a high vegetable and fruit diet with beans and whole grains and seeds and nuts, regular exercise, weight management, and stress reduction. All of this should also help to maintain a normal blood pressure, which also reduces stroke risk. Taking dietary supplements can also help.
In a new study from Japan, researchers followed 72,180 men and women who were free of cardiovascular diseases and cancer at the start of the study in 1988 to 1990. They then estimated the risk of stroke in relation to multivitamin use. The subjects were followed for 19 years, during which they identified 2087 deaths from stroke, including 1148 ischemic strokes (blockage of an artery) and 877 hemorrhagic strokes (bleeding).
After statistical analysis, they found that multivitamin users had a statistically significant 20 percent lower risk of ischemic stroke, but only a non-significant 4 percent reduction in hemorrhagic stroke. The association was particularly evident among regular users of multivitamins rather than occasional users. Overall, stroke risk was 13 percent lower when combining both types of stroke. The most significant benefits were among those people with a low fruit and vegetable intake. (Dong JY, et al., Multivitamin use and risk of stroke mortality: the Japan collaborative cohort study. Stroke. 2015 May;46(5):1167-72.)
Taking multivitamins helps provide some insurance against chronic diseases, in this case stroke. However, it is clear from this study that eating a lot of fruits and vegetables may reduce these particular benefits from multivitamins. Nonetheless, other studies have shown other benefits from regular vitamin consumption, including multivitamins. My diet is rich in fruits and vegetables, but I still regularly take a comprehensive multivitamin.
Magnesium is an important major mineral in the diet with well over 300 enzyme systems dependent on it. It is essential for bone formation (in addition to calcium), activation of B-complex vitamins, muscle relaxation, and energy production. In addition, it is essential for the secretion and activity of insulin, making it important for diabetics. It is found in abundance in dark, leafy green vegetables (it is the central atom in chlorophyll, giving its green color), as well as whole grains, beans, and nuts. (Soy bean curd (tofu) is often made with magnesium chloride as the curdling agent, in which case it contains even more magnesium.) Low or borderline magnesium intake is common with typical industrialized food sources, which is increasingly pervasive around the world. In the U.S. it is typical for adults to be 100 to 200 mg short of the daily need for magnesium.
Taking data from the National Health and Nutrition Examination Survey (NHANES) from 2001-2010, researchers examined the relationship of magnesium intake to risk factors for diabetes in 14,388 men and women aged 19 and older. A higher intake from both food and supplements was significantly associated with reduced obesity, smaller waist circumference, higher HDL-cholesterol levels, less metabolic syndrome, and reduced systolic blood pressure. (Papanikolaou Y, et al., (2014) Dietary magnesium usual intake is associated with favorable diabetes-related physiological outcomes and reduced risk of metabolic syndrome: An NHANES 2001-2010 analysis. J Hum Nutr Food Sci 2014 October 15;2(3): 1038.)
A diet rich in magnesium is likely to be beneficial in many ways, as it is rich in vegetables, beans whole grains, nuts (almonds, especially), and seeds (sesame seeds, for example). However, it is likely to be beneficial for people to take supplements of magnesium, partly because the recommended amount of dietary magnesium is lower than what many experts think is adequate. I take 200 mg of magnesium aspartate, which is a well-absorbed form, as are the citrate and malate forms. Magnesium carbonate and magnesium oxide are not absorbed as well.
The intake of whole grains and cereal fiber is inversely related to the risk of developing chronic diseases, although many so-called experts have suggested that they are the cause of many diseases rather than a preventive. In fact, they lower the risk of cancer, cardiovascular disease, diabetes, obesity, and hypertension. In a recent study, researchers set out to determine the relationship of whole grain consumption with total and disease-specific mortality. They included data on 367,442 participants in the NIH-AARP Diet and Health Study, enrolled in 1995 and followed until 2009.
Over an average of 14 years of follow-up, they documented 46,067 deaths. As compared with participants with the lowest intake of whole grains, those with the highest intake had a 17 percent lower risk of all-cause mortality. The risk reduction for disease-specific mortality ranged from 11 to 48 percent. Those with the highest intake of cereal fiber had a 19 percent lower all-cause mortality risk, and a 15 to 34 percent lower risk of disease-specific mortality. The authors suggested increased consumption of whole grains and a reduction of intake of refined carbohydrates (primarily white flour and sugar). (Huang T, et al., Consumption of whole grains and cereal fiber and total and cause-specific mortality: prospective analysis of 367,442 individuals. BMC Med. 2015 Mar 24;13:59.)
This study adds to the information that I reported in February from another study on whole grains with similar conclusions. That prospective study included over 118,000 men and women and followed them for 26 years, and they found a 9 percent reduction in all-cause mortality and a 15 percent lower mortality from cardiovascular disease in those who consumed the most whole grains compared to those who ate the lease. Unlike other studies, they did not find a reduction in cancer mortality.
I have recognized the benefits of whole grains since the early 1970s, before I started to practice clinical medicine. Since that time, I have avoided white flour and white rice (as well as sugar and other heavily processed foods). I have recommended this to my patients ever since.
Whole grains can be prepared in a wide variety of ways that are tasty and healthful. Whole grains include whole wheat, brown rice, corn, rye, oats, barley, millet, and quinoa (an increasingly popular and versatile grain). Buckwheat, amaranth, and wild rice are not true grains, but they are associated with the grain family because of their similar culinary properties and nutritional profiles. Oatmeal is a simple whole grain meal, to which you can add nuts, raisins, bananas, and other ingredients for flavor variety.
Some of my colleagues have written extensively on what they purport to be the dangers of grains in general, and wheat in particular, in relation to chronic disease, including brain degeneration. The data from epidemiological studies and prospective analyses do not support their position, although it is true that some people are seriously sensitive to gluten, a protein found in wheat, rye, barley, kamut, and spelt.
The incidence of gluten sensitivity (celiac disease) is about one percent of the North American population, although undiagnosed cases may make the actual incidence slightly higher than that. Some people appear to have sensitivity to grains that is unrelated to gluten, and they feel better when they avoid those grains. (In fact, many people have allergies or sensitivities to all sorts of foods aside from grains.) The availability of gluten-free products is important for those few people who have celiac disease, but the space in the market devoted to those foods is disproportionate to the number of people at risk. In addition, these foods often contain sugar and other unhealthy ingredients in an attempt by manufacturers to reproduce some of the taste, texture, and mouth feel of the missing gluten. I wish people were as concerned with buying organic foods as they are with avoiding gluten.
Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) shows that specific nutrients may reduce the risk for pancreatic cancer. Researchers looked at 446 patients with pancreatic cancer and matched them to 446 controls. They measured the plasma levels of carotenoids (alpha- and beta-carotene, lycopene, beta-cryptoxanthin, canthaxanthin, zeaxanthin, and lutein), alpha- and gamma-tocopherol, retinol, and vitamin C. They then evaluated the pancreatic cancer risk after adjusting for many variables. These variables included age at blood collection, sex, fasting status, and hormone use, as well as smoking history, waist circumference, and diabetes status.
They found that the highest levels of beta-carotene were associated with a 48 percent risk reduction for pancreatic cancer. They also found a 47 percent risk reduction for those with the highest levels of zeaxanthin compared to the lowest. In addition, high levels of alpha-tocopherol lowered the pancreatic cancer risk by 38 percent, but this did not quite reach statistical significance. (Jeurnink SM, et al., Plasma carotenoids, vitamin C, retinol and tocopherols levels and pancreatic cancer risk within the European Prospective Investigation into Cancer and Nutrition: a nested case-control study: plasma micronutrients and pancreatic cancer risk. Int J Cancer. 2015 Mar 15;136(6):E665-76.)
An earlier study evaluated pancreatic cancer risk relative to nutrient intake. They found that those whose food diaries indicated that they were in the top three quartiles for intake of vitamins C and E and selenium had a 67 percent lower risk of developing pancreatic cancer than those in the lowest quartile. For vitamin C, high serum levels were associated with a 33 percent lower risk, but this did not correlate with the subjects’ food diaries. (Banim PJ, et al., Dietary antioxidants and the aetiology of pancreatic cancer: a cohort study using data from food diaries and biomarkers. Gut. 2013 Oct;62(10):1489-96.) It is not clear whether the food diaries included supplementation, so serum levels would be a more accurate reflection of vitamin C intake.
Again, diets that are high in important micro-nutrients are related to lower disease risk. Supplements that further raise the blood levels of vitamins C and E as well as carotenoids, selenium, and tocopherol may well provide even greater benefits in the prevention of chronic diseases, including cancer.