Tuesday, May 23, 2017
Drinking just one glass of wine or other alcoholic drink a day increases breast cancer risk, finds a major new report by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF).
The report also revealed, for the first time, that vigorous exercise such as running or fast bicycling decreases the risk of both pre- and post-menopausal breast cancers. Strong evidence confirmed an earlier finding that moderate exercise decreases the risk of post-menopausal breast cancer, the most common type of breast cancer.
"It can be confusing with single studies when the findings get swept back and forth," said Anne McTiernan, MD, PhD, a lead author of the report and cancer prevention expert at the Fred Hutchinson Cancer Research Center.
"With this comprehensive and up-to-date report the evidence is clear: Having a physically active lifestyle, maintaining a healthy weight throughout life and limiting alcohol -- these are all steps women can take to lower their risk."
Brisk Walking, Alcohol and Breastfeeding
Diet, Nutrition, Physical Activity and Breast Cancer systematically collated and evaluated the scientific research worldwide on how diet, weight and exercise affect breast cancer risk in the first such review since 2010. The report analyzed 119 studies, including data on 12 million women and 260,000 cases of breast cancer.
The report found strong evidence that drinking the equivalent of a small glass of wine or beer a day (about 10 grams alcohol content) increases pre-menopausal breast cancer risk by 5 percent and post-menopausal breast cancer risk by 9 percent. A standard drink is 14 grams of alcohol.
For vigorous exercise, pre-menopausal women who were the most active had a 17 percent lower risk and post-menopausal women had a 10 percent lower risk of developing breast cancer compared to those who were the least active. Total moderate activity, such as walking and gardening, linked to a 13 percent lower risk when comparing the most versus least active women.
In addition the report showed that:
Being overweight or obese increases the risk of post-menopausal breast cancer, the most common type of breast cancer.
Mothers who breastfeed are at lower risk for breast cancer.
Greater adult weight gain increases risk of post-menopausal breast cancer.
Breast cancer is the most common cancer in US women with over 252,000 new cases estimated this year. AICR estimates that one in three breast cancer cases in the U.S. could be prevented if women did not drink alcohol, were physically active and stayed a healthy weight.
Emerging Findings: Dairy and Veggies
The report points to links between diet and breast cancer risk. There was some evidence -- although limited -- that non-starchy vegetables lowers risk for estrogen-receptor (ER) negative breast cancers, a less common but more challenging to treat type of tumor.
Limited evidence also links dairy, diets high in calcium and foods containing carotenoids to lowering risk of some breast cancers. Carrots, apricots, spinach and kale are all foods high in carotenoids, a group of phytonutrients studied for their health benefits.
These links are intriguing but more research is needed, says McTiernan. "The findings indicate that women may get some benefit from including more non-starchy vegetables with high variety, including foods that contain carotenoids," she said. "That can also help avoid the common 1 to 2 pounds women are gaining every year, which is key for lowering cancer risk."
Steps Women Can Take
Aside from these lifestyle risk factors, other established causes of breast cancer include being older, early menstrual period and having a family history of breast cancer.
While there are many factors that women cannot control, says Alice Bender, MS, RDN, AICR's Head of Nutrition Programs, the good news from this report is that all women can take steps to lower their breast cancer risk.
"Wherever you are with physical activity, try to nudge it up a bit, either a little longer or a little harder. Make simple food shifts to boost protection -- substitute veggies like carrots, bell peppers or green salad for chips and crackers and if you drink alcohol, stick to a single drink or less," said Bender.
"There are no guarantees when it comes to cancer, but it's empowering to know you can do something to lower your risk."
You can find the recommended dietary allowance (RDA) on the nutrition labels of all your processed food. Food manufacturers are obliged to list the nutritional value of their products, and therefore must mention the percent daily value of the RDA their product meets for certain nutrients.
These RDA guidelines are put together by the Food and Nutrition Board of the National Academy of Sciences' Institute of Medicine. They inform you how much of a specific nutrient your body minimally needs every day. They are set to meet the requirements of 97.5% of the healthy individuals older than 19 years.
The RDA you will find on the nutrition labels on your food, however, were set in 1968, and the ones used by researchers and professionals were set in 2003. A recent review published in Frontiers in Nutrition points out that both these values do not do justice to the protein needs of the elderly and critically ill.
"A big disservice is being done. The prescribed 0.8 g/kg/day just isn't enough protein for the elderly and people with a clinical condition. This shouldn't be communicated as what is 'allowed' or even 'recommended' to eat.", author Stuart Phillips of McMaster University in Canada explains.
In his review, he points out that the quality of proteins should be considered when setting the RDA guidelines and recommending protein supplements. He argues that there should be a stronger focus on leucine; an indispensable amino acid and building block for proteins. The elderly have a higher need for leucine to build muscle proteins, and milk-based proteins (e.g. milk and whey) are a good source for this.
Moreover, it may be highly beneficial for the critically ill patients that rapidly lose lean body mass (i.e. the body weight minus body fat) to increase their protein intake. Again, elderly ill patients would benefit the most from this. "I think it's clear we need some longer-term clinical trials with older people on higher protein intakes. These trials need to consist of around 400 - 500 people.", Phillips argues.
He is not the first researcher to challenge the current protein RDA, and hopes his message does not fall on deaf ears. That is also why he chose to publish Open Access: "I love to publish work that everyone can read. The days of publishing a paper that only people in academic institutions can read are over. I think it is essential that everyone and not only your scientific colleagues can read the work we do."
At his own dinner table, Phillips also puts the focus on proteins. "But not at the expense of other macronutrients. I enjoy a variety of foods, and the only thing I specifically focus on is limiting my intake of sugar and refined carbohydrates. But of course, given the benefits of proteins, they are a big part of what I think about when planning my meals."
Many women start fitness programs to lose weight, and when they don't, they feel like failures and stop exercising.
And then, months or a year later, they do the same thing again--creating a vicious cycle that fails to consider what might be leading to short-term motivation, says Michelle Segar, director of the University of Michigan's Sport, Health, and Activity Research and Policy Center.
In a new study funded internally by the National Cancer Institute, Segar and co-investigators analyzed what women say makes them feel happy and successful, and how their expectations and beliefs about exercise foster or undermine those things.
"A new understanding of what really motivates women might make an enormous difference in their ability to successfully incorporate physical activity into their daily routine--and have fun doing it," said Segar, who is also a researcher at the U-M Institute for Research on Women and Gender.
The findings, which will appear in the journal BMC Public Health, show that both active and inactive women report the same ingredients for feeling happy and successful:
Connecting with and helping others be happy and successful.
Being relaxed and free of pressures during their leisure time. Accomplishing goals of many sorts (from grocery shopping to career goals).
But the study also found that for inactive women, their beliefs and expectations about exercise actually thwarted the things that make them feel happy and successful:
They believe "valid" exercise must be intense, yet they want to feel relaxed during their leisure time.
They feel pressured to exercise for health or to lose weight, yet during their leisure time they want to be free of pressures. Success comes from achieving goals, yet their expectations about how much, where and how they should be exercising means they can't achieve these goals.
"The direct conflict between what these low-active women believe they should be doing when they exercise, and their desire to decompress and renew themselves during leisure time, demotivates them," Segar said. "Their beliefs about what exercise should consist of and their past negative experiences about what it feels like actually prevents them from successfully adopting and sustaining physically active lives."
Segar and co-investigators Jennifer Taber, Heather Patrick, Chan Thai and April Oh conducted eight focus groups among white, black and Hispanic women aged 22-49 who were either categorized as "high active" or "low active."
While the findings about happiness and success seemed to hold true for both groups in the different demographics, low-active women held distinctly different views than high-active women about exercising.
"We've all been socialized to exercise and be physically active for the last 30 years," said Segar. "The traditional recommendation we've learned to believe is that we should exercise at a high intensity for at least 30 minutes, for the purpose of losing weight or improving our health. Even though there are newer recommendations that permit lower intensity activity in shorter durations most people don't know or even believe it."
This more traditional message has worked for a small minority of the population, but more generally it has failed to increase population physical activity, she says.
"This traditional approach to exercising might actually harm exercise motivation. Our study shows that this exercise message conflicts with and undermines the very experiences and goals most women have for themselves," she said.
The exceptions found in the study were among the more active participants, who held more flexible views of exercise. They expressed that it "was not the end of the world" if they had to skip exercising once in awhile. They made exercise more of a "middle priority," which took the pressure off and left room for compromise when schedules and responsibilities did not permit planned exercise to occur.
The high-active women seemed to have more positive feelings from exercising, in contrast to most of the low-active women, who, in general, tended to dread the very idea of it.
"There are important implications from this study on how we can help women better prioritize exercise in their day-to-day life," Segar said. "We need to re-educate women they can move in ways that will renew instead of exhaust them, and more effectively get the message across that any movement is better than nothing. To increase motivation to be physically active, we need to help women to want to exercise instead of feeling like they should do it."
This can be achieved by:
- Re-educating women that movement can and should feel good to do.
- Promoting physical activity as a way to connect with important others.
- Reframing physical activity as a vehicle that helps women renew and re-energize themselves to better succeed at their daily roles and goals.
- Explain physical activity as a broad continuum that counts all movement as valid and worth doing.
Probiotics may relieve symptoms of depression, as well as help gastrointestinal upset, research from McMaster University has found.
In a study published in the medical journal Gastroenterology (May 2), researchers of the Farncombe Family Digestive Health Research Institute found that twice as many adults with irritable bowel syndrome (IBS) reported improvements from co-existing depression when they took a specific probiotic than adults with IBS who took a placebo.
The study provides further evidence of the microbiota environment in the intestines being in direct communication with the brain said senior author Dr. Premysl Bercik, an associate professor of medicine at McMaster and a gastroenterologist for Hamilton Health Sciences.
"This study shows that consumption of a specific probiotic can improve both gut symptoms and psychological issues in IBS. This opens new avenues not only for the treatment of patients with functional bowel disorders but also for patients with primary psychiatric diseases," he said.
IBS is the most common gastrointestinal disorder in the world, and is highly prevalent in Canada. It affects the large intestine and patients suffer from abdominal pain and altered bowel habits like diarrhea and constipation. They are also frequently affected by chronic anxiety or depression.
The pilot study involved 44 adults with IBS and mild to moderate anxiety or depression. They were followed for 10 weeks, as half took a daily dose of the probiotic Bifidobacterium longum NCC3001, while the others had a placebo.
At six weeks, 14 of 22, or 64%, of the patients taking the probiotic had decreased depression scores, compared to seven of 22 (or 32%) of patients given placebo.
Functional Magnetic Resonance Imaging (fMRI) showed that the improvement in depression scores was associated with changes in multiple brain areas involved in mood control.
"This is the result of a decade long journey - from identifying the probiotic, testing it in preclinical models and investigating the pathways through which the signals from the gut reach the brain," said Bercik.
"The results of this pilot study are very promising but they have to be confirmed in a future, larger scale trial," said Dr. Maria Pinto Sanchez, the first author and a McMaster clinical research fellow.
The study was performed in collaboration with scientists from Nestlé.
Monday, May 22, 2017
Analysis of data from older adults who participated in a clinical trial showed no benefit of a statin for all-cause mortality or coronary heart disease events when a statin was started for primary prevention in older adults with hypertension and moderately high cholesterol, according to a new article published by JAMA Internal Medicine.
Many older patients take statins for primary cardiovascular prevention but data are limited on the risks and benefits of statins for primary prevention in this age group. Improving the understanding of preventive interventions in older patients has implications for health care and its costs.
Benjamin H. Han, M.D., M.P.H., of the New York University School of Medicine, and coauthors analyzed data from older adults in the Lipid-Lowering Trial (LLT) component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT), which was conducted from 1994 to 2002.
The authors used an analytical sample that included 2,867 adults with hypertension but without baseline atherosclerotic cardiovascular disease (plaque build-up in the arteries). Of the 2,867 adults, 1,467 were in the pravastatin sodium group (40 mg per day) and 1,400 received usual care from their primary care physician to lower cholesterol.
The authors report no benefit of pravastatin for the main outcome of all-cause mortality or secondary outcomes of coronary heart disease events and cause-specific mortality. More deaths occurred in the pravastatin group than in the usual care group (141 vs. 130) among adults 65 to 74 and among adults 75 and older (92 vs. 65). There were 76 CHD events in the pravastatin group compared with 89 in the usual care group among adults 65 to 74 and 31 CHD events compared with 39 among adults 75 and older, according to the results. Stroke, heart failure and cancer rates were similar in the two treatment groups for both age groups.
Authors note limitations of the current study, which include its design as a post hoc secondary analysis of a trial of a subgroup of patients.
"No benefit was found when a statin was given for primary prevention to older adults. Treatment recommendations should be individualized for this population," the article concludes.
Many people believe that having a glass of wine with dinner--or moderately drinking any kind of alcohol--will protect them from heart disease. But a hard look at the evidence finds little support for that.
That's the conclusion of a new research review in the May 2017 issue of the Journal of Studies on Alcohol and Drugs.
Over the years, studies have found that adults who drink moderately have lower heart disease rates than non-drinkers. That has spurred the widespread belief that alcohol, in moderation, does a heart good.
But the new analysis, of 45 previous cohort studies, reveals the flaws in that assumption: A central issue is that "non-drinkers" may, in fact, be former drinkers who quit or cut down for health reasons.
Furthermore, seniors who are healthy may be more likely to keep enjoying that glass of wine with dinner.
"We know that people generally cut down on drinking as they age, especially if they have health problems," said researcher Tim Stockwell, Ph.D., director of the Centre for Addictions Research at the University of Victoria, in British Columbia, Canada.
"People who continue to be moderate drinkers later in life are healthier," Stockwell said. "They're not sick, or taking medications that can interact with alcohol."
And in studies, that can lead to a misleading association between moderate drinking and better health.
In their analysis, Stockwell's team found that overall, "current" moderate drinkers (up to two drinks per day) did, in fact, have a lower rate of heart disease death than non-drinkers.
However, that was not the case in studies that looked at people's drinking habits at relatively young ages -- age 55 or earlier -- and followed them to their older years when heart disease might strike. Similarly, studies that rigorously accounted for people's heart health at baseline indicated no benefits from moderate drinking.
According to Stockwell, it all suggests that "abstainers" tend to be less healthy than moderate drinkers--but not because they never drank. Instead, their health may influence their drinking choices. That is, they may not drink because their health is poor.
"We can't 'prove' it one way or the other," Stockwell noted. "But we can say there are grounds for a healthy skepticism around the idea that moderate drinking is good for you."
A second study in the same issue supports that.
That research followed more than 9,100 U.K. adults from the age of 23 to 55. Overall, researchers found that people's drinking habits evolved over time--and few were actually lifelong "abstainers." Nearly all people who were non-drinkers at age 55 had given up alcohol.
What's more, non-drinkers--even those in their 20s--tended to be in poorer physical and mental health compared with those who drank moderately and did not smoke. They were also, on average, less educated, and education is an important factor in lifetime health.
However, no one is saying that people who enjoy alcohol in moderation should stop.
"The risks of low-level drinking are small," Stockwell said. But, he added, people should not drink solely because they believe it wards off disease.
"The notion that one or two drinks a day is doing us good may just be wishful thinking," Stockwell said.
Friday, May 19, 2017
Fennel, an anise-flavored herb used for cooking, has long been known for its health benefits for a variety of issues, including digestion and premenstrual symptoms. A new study confirms that it is also effective in the management of postmenopause symptoms such as hot flashes, sleeplessness, vaginal dryness, and anxiety, without serious side effects. The study outcomes are published online today in Menopause, the journal of The North American Menopause Society (NAMS).
The use of complementary and alternative medicine for the management of menopause symptoms has surged in recent years as women have attempted to identify alternatives to hormone therapy (HT). Although HT is the most effective treatment for managing most menopause symptoms, some women have turned to herbal medicine because they are either not candidates for HT or are concerned about the negative publicity surrounding potential side effects. Fennel, an herb containing essential oils, has phytoestrogenic properties. Phytoestrogens are estrogen-like chemicals in plants that have been used to effectively treat a wide array of menopause symptoms.
In this small trial of 79 Iranian women aged 45 to 60 years, soft capsules containing 100 mg of fennel were administered twice daily for eight weeks. Improvements were compared between the intervention and placebo groups at four, eight, and 10 weeks, with a significant statistical difference documented. In the end, fennel was concluded to be a safe and effective treatment to reduce menopause symptoms without serious side effects. The study described in the article "Effect of Foeniculum vulgare Mill. (fennel) on menopausal symptoms in postmenopausal women: a randomized, triple-blind, placebo-controlled trial" is one of the first clinical studies to examine the benefits of fennel for managing menopause symptoms, even though it had been previously studied and confirmed to manage premenopause symptoms.
The study was completed in Tehran, Iran, where the average age of women at menopause is younger than in the United States: 48.2 years versus 51 years, respectively. Some of the most common adverse effects of menopause are hot flashes, vaginal dryness, sleep problems, joint and muscular discomfort, exhaustion, irritability, anxiety, and depression.
"This small pilot study found that, on the basis of a menopause-rating scale, twice-daily consumption of fennel as a phytoestrogen improved menopause symptoms compared with an unusual minimal effect of placebo," says Dr. JoAnn Pinkerton, executive director of NAMS. "A larger, longer, randomized study is still needed to help determine its long-term benefits and side effect profile."