Friday, May 16, 2008

WANT TO LIVE AN EXTRA 14 YEARS?

DON'T SMOKE
BE PHYSICALLY ACTIVE
MODERATE ALCOHOL INTAKE
EAT 5 SERVINGS OF FRUITS AND VEGETABLES DAILY

This important study reported in January in the Journal PLosMedicine is elegant in it's simplicity and rigorous in its follow-up and analysis.

Between 1993 and 1997, about 20,000 men and women aged 45–79 living in Norfolk UK, none of whom had cancer or cardiovascular disease (heart or circulation problems), completed a health and lifestyle questionnaire, had a health examination, and had their blood vitamin C level measured as part of the EPIC-Norfolk study.

A health behavior score of between 0 and 4 was calculated for each participant by giving one point for each of the following healthy behaviors:
1) Current non-smoking
2) Not physically inactive (physical inactivity was defined as having a sedentary job and doing no recreational exercise)
3) Moderate alcohol intake (1–14 units a week; a unit of alcohol is half a pint of beer, a glass of wine, or a shot of spirit)
4) A blood vitamin C level consistent with a fruit and vegetable intake of at least five servings a day.

Deaths among the participants were then recorded until 2006. After allowing for other factors that might have affected their likelihood of dying (for example, age), people with a health behavior score of 0 were four times as likely to have died (in particular, from cardiovascular disease) than those with a score of 4. People with a score of 2 were twice as likely to have died.

What Do These Findings Mean?

These findings indicate that the combination of four simply defined health behaviors predicts a 4-fold difference in the risk of dying over an average period of 11 years for middle-aged and older people. They also show that the risk of death (particularly from cardiovascular disease) decreases as the number of positive health behaviors increase.

Finally, they can be used to calculate that a person with a health score of 0 has the same risk of dying as a person with a health score of 4 who is 14 years older. They strongly suggest that modest and achievable lifestyle changes have a marked effect on the health of populations. Quality of life is strongly correlated with mortality.

Two other things struck me;
1) those who took vitamin supplements had no increase death rate, contradicting the meta-analysis mentioned in a previous post.
2) it reinforces the importance of fruits and vegetables as a source of vitamins, minerals and anti-inflammatory and antioxidant nutrients.

PLoS Medicine - Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study

PLoS Medicine - Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study: "What Do These Findings Mean?

These findings indicate that the combination of four simply defined health behaviors predicts a 4-fold difference in the risk of dying over an average period of 11 years for middle-aged and older people. They also show that the risk of death (particularly from cardiovascular disease) decreases as the number of positive health behaviors increase. Finally, they can be used to calculate that a person with a health score of 0 has the same risk of dying as a person with a health score of 4 who is 14 years older. These findings need to be confirmed in other populations and extended to an analysis of how these combined health behaviors affect the quality of life as well as the risk of death. Nevertheless, they strongly suggest that modest and achievable lifestyle changes could have a marked effect on the health of populations. Armed with this information, public-health officials should now be in a better position to encourage behavior changes likely to improve the health of middle-aged and older people."

PLoS Medicine - Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study

PLoS Medicine - Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study: "What Did the Researchers Do and Find?
Between 1993 and 1997, about 20,000 men and women aged 45–79 living in Norfolk UK, none of whom had cancer or cardiovascular disease (heart or circulation problems), completed a health and lifestyle questionnaire, had a health examination, and had their blood vitamin C level measured as part of the EPIC-Norfolk study. A health behavior score of between 0 and 4 was calculated for each participant by giving one point for each of the following healthy behaviors: current non-smoking, not physically inactive (physical inactivity was defined as having a sedentary job and doing no recreational exercise), moderate alcohol intake (1–14 units a week; a unit of alcohol is half a pint of beer, a glass of wine, or a shot of spirit), and a blood vitamin C level consistent with a fruit and vegetable intake of at least five servings a day. Deaths among the participants were then recorded until 2006. After allowing for other factors that might have affected their likelihood of dying (for example, age), people with a health behavior score of 0 were four times as likely to have died (in particular, from cardiovascular disease) than those with a score of 4. People with a score of 2 were twice as likely to have died."

Wednesday, May 14, 2008

Selective Science

We were concerned when the headlines screamed "Antioxidants increase mortality" "Antioxidants do no good, may harm". The article below demonstrates how "selective science" can lead to misinformation. Sadly most reporters read no further than the first line, adding to the confusion.

One of the reasons for founding Healthy Humans Foundation is to sort through the nonsense and provide you with the most accurate information about your health.

Article in NutraIngredients.com:

A meta-analysis of 67 randomised trials with antioxidant supplements has reported that vitamins A and E, and beta-carotene may increase mortality risk by up to 16 per cent.

On the other hand, vitamin C did not have an effect on mortality and the antioxidant mineral selenium was associated with a nine per cent decrease in all-cause mortality.

"We could find no evidence to support taking antioxidant supplements to reduce the risk of dying earlier in healthy people or patients with various diseases," said Goran Bjelakovic from the Copenhagen Trial Unit at the Copenhagen University Hospital in Denmark.

A republishing of last year's antioxidant meta-analysis in the prestigious Cochrane Systematic Review today looks set to refocus attention on the efficacy of antioxidant supplements, and raise questions over their safety.
The meta-analysis was originally published in the Journal of the American Medical Association (2007, Vol. 297, pp. 842-857) last year and attracted criticism from both inside and outside of the dietary supplements industry.
The authors admit that this report contained errors and corrections were subsequently published in JAMA (2008, Vol. 299, pp. 765-766). "The present version of the review incorporates all these corrections," they state.

Review details

Bjelakovic and collaborators from the University of Nis in Serbia, and Ospedale V. Cervello in Palermo, followed the Cochrane Collaboration method for meta-analysis and systematically reviewed 67 randomised clinical trials including 232,550 participants, and focusing on beta-carotene, vitamin A, vitamin C, vitamin E, and selenium supplements versus placebo.
Seven hundred and forty seven trials were excluded for several reasons, including no mortality in the study groups (405 trials), the studies were not randomised trials (69 trials), they did not fulfil inclusion criteria (245 trials), or the studies are ongoing (four).
Bjelakovic and co-workers report no reduction in mortality, and note that 13.1 per cent of the participants randomised to antioxidant supplements died, compared to 10.5 per cent randomised to placebo or no intervention.

"The findings of our review show that if anything, people in trial groups given the antioxidants beta-carotene, vitamin A, and vitamin E showed increased rates of mortality. There was no indication that vitamin C and selenium may have positive or negative effects. So regarding these antioxidants we need more data from randomised trials," said Bjelakovic.

"The bottom line is that current evidence does not support the use of antioxidant supplements in the general healthy population or in patients with certain diseases.

"The reviewers highlighted several possible explanations or mechanisms behind the potentially detrimental effects of antioxidant supplements, noting that elimination of free radicals may interfere with some essential defensive mechanisms, including programmed cell death (apoptosis), detoxification, and phagocytosis. "Better understanding of mechanisms and actions of antioxidants in relation to a potential disease is needed," they added.

Dr. Bjelakovic was contacted by NutraIngredients.com and asked to comment on the exclusion of the 405 death-free trials, and to contextualise why most of the trials included in the meta-analysis tested for secondary prevention, looking at how a nutrient works in diseased populations, instead of primary prevention studies in healthy populations. No response was received by NutraIngredients.com in time for publication.

Stinging criticism

The dietary supplements industry has responded strongly to the review, with the Council for Responsible Nutrition (CRN), an industry association, releasing a statement that read:

"Although [the authors] have updated their meta-analysis, by handpicking additional studies and correcting a litany of minor mistakes made in previous versions, it is for all intents and purposes not a new study, nor is it truly new information.

"In fact, it appears to be a systematic attempt by the authors to publish work that supports their own pre-determined conclusions about antioxidants and the way they should be regulated."

John Hathcock, Ph.D., senior vice president, scientific and international affairs, CRN, was quick to draw attention to the exclusion criteria employed by the researchers.
"With nearly 750 studies to choose from, it's interesting that they chose to include only 67 studies - less than nine percent of the total clinical trials on antioxidants that are available," said Dr. Hancock.

"Moreover, the possible 750 clinical trials do not even account for other sources of evidence, such as observational studies, which were not considered by the authors at all. It is their exclusions, not the inclusions, where the fault lies."

"The conclusions one can reach from this meta-analysis are very limited."When the meta-analysis was published initially in JAMA, Meir Stampfer, a professor of nutrition and epidemiology at the Harvard School of Public Health who was not connected to the meta-analysis, told the Associated Press that the studies reviewed were too different to be able to pool them together.

"This study does not advance our understanding, and could easily lead to misinterpretation of the data," Stampfer told the AP.Similar comments were forthcoming from the UK natural health industry association, the Health Food Manufacturers' Association (HFMA). A spokesperson stated that the review was "systematically flawed."

"The analysis focused on one broad category of study, then evaluated just 67 of the 748 studies that could be included in the review. Therefore, the paper's conclusions are drawn on less than nine per cent of available evidence.

In no way can this review be considered comprehensive," said the spokesperson."Antioxidant supplements cannot be expected to undo a lifetime of unhealthy living, but combined with good lifestyle choices, can play an important role in promoting overall health and wellbeing."Pointing out the practicalities Andrew Shoa, Ph.D., CRN's vice president, scientific and regulatory affairs said: "It really comes down to whether or not this meta-analysis should mean anything to consumers or scientists. And from a practical standpoint, it doesn't mean much.

"We maintain that healthy consumers who are using antioxidant supplements in the manner that they were meant to be used-as complements to, not in place of-other healthy lifestyle habits, can continue to feel confident in the benefits these supplements provide. "For those consumers who are seriously ill with cancer, heart disease, etc., they should talk with their doctor about everything they put into their bodies."Source: Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD007176. DOI: 10.1002/14651858.CD007176."Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases"Authors: G. Bjelakovic, D. Nikolova, L.L. Gluud, R.G. Simonetti, C. Gluud

Preventing Heart Disease with Fruit Juice

This well done study demonstrates that atherosclerosis can be prevented by anti-oxidants from fruit sources. The fatty streaks in the arteries was reduced by 93% by the consumption of purple grape juice which is rich vitamin C along with polyphenols and caretenoids. This study showed that the juice was more powerful than the fruit.

Dr. Lundell

Long term supplementation of antioxidant-rich apples and purple grapes, particularly in juice form, may prevent artery hardening, researchers from France have reported for the first time.

Measures of atherosclerosis were reduced in hamsters with high cholesterol levels following consumption of the fruit and their respective juices, but the benefits were significantly greater for the juices, report researchers from the University of Montpellier 1 and 2, and the Victor Ségalen University in Bordeaux 2 in the journal Molecular Nutrition & Food Research."The present results clearly show for the first time that apple and purple grape prevent diet-induced atherosclerosis in hamsters, and that the fruit processing can have a major impact on the potential health benefits of fruit in pathological conditions," wrote the researchers, led by Jean-Max Rouanet. "These findings, therefore, provide encouragement that fruit and fruit juices may have a significant clinical and public health relevance."

Atherosclerosis, or hardening of the arteries, is a major risk factor for cardiovascular disease (CVD), which causes almost 50 per cent of deaths in Europe, and is reported to cost the EU economy about €169bn ($202bn) per year.

New dataRouanet and co-workers took 40 male Syrian golden hamsters and randomly divided them into five groups. The animals were fed a diet to promote the development of artery hardening, and supplemented with mashed apple or purple grape, or the same volume of apple juice or purple grape juice, or water (control group) for 12 weeks.At the end of the study, they found that total cholesterol levels were significantly reduced in the animals fed the fruit-supplemented diets, by 11 per cent in apple group and 24 per cent in the apple juice group, and 30 per cent in the purple grape and 34 per cent in the purple grape juice group. This was attributed to the reductions in levels of non-HDL cholesterol.The juices also outperformed the fruit for protecting against atherosclerosis, measured by the aortic fatty streak lesion area or AFSA. This value was reduced by 93 and 78 per cent for the purple grape juice and the fruit, respectively, and by 60 and 48 per cent for apple juice and apple, respectively.

"The results show for the first time that long-term consumption of antioxidants supplied by apple and purple grape, especially phenolic compounds, prevents the development of atherosclerosis in hamsters, and that processing can have a major impact on the potential health benefits of a product," stated the researchers.

Mechanism of protection; Commenting on the underlying mechanism, Rouanet and co-workers stated that the greater potency of the purple grape and its juice may be due to the flavonoids content.

"Flavonoids, especially anthocyanins and catechins in purple grape and purple grape juice, generally have more hydroxyl groups than phenolic acids found in apple and apple juice," wrote the authors. "This could explain why purple grape juice and purple grape displayed a better efficacy than apple and apple juice against early atherosclerosis. "Nevertheless, these beneficial effects cannot only be attributed to their phenolic contents, but to the result of the action of different antioxidant compounds present in the fruits (vitamin C, carotenoids, polyphenols) and to possible synergistic and antagonist effects still unknown," they added.

Source: Molecular Nutrition & Food Research2008, Volume 52, Pages 400-407, doi: 10.1002/mnfr.200700141"Phenolics from purple grape, apple, purple grape juice and apple juice prevent early atherosclerosis induced by an atherogenic diet in hamsters"Authors: Kelly Décorde, P.-L. Teissèdre, C. Auger, J.-P. Cristol, J.-M. Rouanet

Fish Oil, Low Calorie Diet Reduce the Risk of Inflammation

A diet high in fish oil and low in calories could reduce markers of inflammation by up to 90%, according to a study published in the journal Life Sciences.

The study looked at the effects of fish oil and/or low-calorie diets on markers of inflammation-such as lipid oxidation levels and concentrations of superoxides, prostaglandins and leukotriene B4-in both young and old mice. The animals received either corn oil or fish oil and those on calorie-restricted diets received the same dosages of corn oil or fish oil as did the controls.

Older mice on the corn oil diet had superoxide levels about 18% higher than their younger counterparts. Younger mice on the calorie-restricted diet had superoxide levels about 35% lower, while for those on the fish oil diet the decrease was about 60%. In calorie-restricted younger mice consuming fish oil, superoxide levels were decreased by 90%.
Life Sciences 78(21):2523-2532, 2006

Dr Lundell's comments:

Oxidative stress occurs when we have more oxidation than the body can overcome with its native antioxidant systems. Oxidative stress is connected with premature aging, cancer,tissue and DNA damage. This study emphasizes the connection between inflammation and oxidation and shows how important Omega 3 from fish oil is in reducing both. Think about this when you order supersize french Fries cooked in corn oil.