Arsenic found in many US red wines, but health risks depend on total diet

A new University of Washington study that tested 65 wines from America's top four wine-producing states -- California, Washington, New York and Oregon -- found all but one have arsenic levels that exceed what's allowed in drinking water.

The U.S. Environmental Protection Agency allows drinking water to contain no more than 10 parts per billion of arsenic. The wine samples ranged from 10 to 76 parts per billion, with an average of 24 parts per billion.

CAPTION

This chart estimates how close minimal, average and heavy consumers of certain foods would come to exceeding maximum recommended arsenic intake levels across their diets. As highlighted, a woman who eats an average amount of rice would get 49 percent of the maximum recommended arsenic "dose" from that one source.

CREDIT

Posted with permission from the Journal of Environmental Health, a publication of the National Environmental Health Association, www.neha.org.

But a companion study concluded that the likely health risks from that naturally-occurring toxic element depend on how many other foods and beverages known to be high in arsenic, such as apple juice, rice, or cereal bars, an individual person eats. The highest risks from arsenic exposure stem from certain types of infant formulas, the study estimated.

The two studies from UW electrical engineering professor Denise Wilson appear on the cover of the October 2015 issue of the Journal of Environmental Health.

"Unless you are a heavy drinker consuming wine with really high concentrations of arsenic, of which there are only a few, there's little health threat if that's the only source of arsenic in your diet," said Wilson.

"But consumers need to look at their diets as a whole. If you are eating a lot of contaminated rice, organic brown rice syrup, seafood, wine, apple juice -- all those heavy contributors to arsenic poisoning -- you should be concerned, especially pregnant women, kids and the elderly."

Arsenic is a naturally occurring element that is toxic to humans in some forms, and can cause skin, lung and bladder cancers, and other diseases. As rain, rivers or wind erode rocks that contain arsenic, it leaches into water and soil. From there, the toxic metalloid can work its way into the food chain.

The UW study is the first peer-reviewed research in decades to look at the arsenic content of American wines. As a group, they had higher arsenic levels than their European counterparts, likely due to the underlying geology of U.S. wine growing regions.

The study looked at red wines, except from two areas in Washington where only white wines were produced, because they are made with the skin of grapes where arsenic that is absorbed from soil tends to concentrate.

Wilson also tested for lead, which is a common co-contaminant. The study found lead in 58 percent of the samples, but only 5 percent -- all from New York -- exceeded drinking water standards.

Washington wines had the highest arsenic concentrations, averaging 28 parts per billion, while Oregon's had the lowest, averaging 13 parts per billion.

"There were no statistical differences among Washington, New York and California," she said. "The only star in the story is Oregon, where arsenic concentrations were particularly low."

Where possible, the study also compared wines grown in "new" vineyards and those that had been converted from other agricultural uses like orchards, where farmers likely used arsenic-based pesticides that were popular in the early 20th century. It found some evidence that higher levels of arsenic in Washington red wines could be a result of pesticide residue.

Because the average adult drinks far more water (between 1.7 and 3.2 cups per day) than even core or frequent wine drinkers (roughly a half cup per day on average), it's an imperfect comparison to gauge health risks based on the EPA drinking water standard of 10 parts per billion. That's why Wilson also evaluated how much arsenic individuals can safely consume from all the sources in their diet.

In a companion study, she compiled consumption data for foods that have been shown to contain arsenic -- juice, milk, bottled water, wine, cereal bars, infant formula, rice, salmon and tuna.

From that, she was able to determine how much of an arsenic "dose" an average child or adult would get from each food source and how close it would come to risk thresholds set by the U.S. Agency for Toxic Substances and Disease Registry for total arsenic consumption across a person's diet.

For the core or frequent adult wine drinker, the arsenic consumed from that single source would only make up 10 to 12 percent of the total maximum recommended daily arsenic intake. But if that person also eats large quantities of contaminated rice, tuna or energy bars, for instance, that could push that individual's arsenic consumption beyond levels that are considered safe.

A person who eats an average or large amount of contaminated rice would get between 41 and 101 percent of the maximum recommended daily dose of arsenic from that one source alone, the study found. A child who drinks apple juice could get a quarter of the maximum daily arsenic dose from that single source.

The food that posed the largest risk of arsenic poisoning was infant formula made with organic brown rice syrup, an alternative to high-fructose corn syrup. Wilson estimated that some infants eating large amounts of certain formulas may be getting more than 10 times the daily maximum dose of arsenic.

Based on recent studies that have found arsenic in numerous foods and beverages, Wilson recommends that U.S. wineries test for arsenic and lead in irrigation and processing water and take steps to remove those contaminants if levels are found to be high.

But rather than litigate against vineyards - as some have done - she would encourage consumers to evaluate their diets more holistically and speak with a doctor if they have concerns. Tests are available that can detect high arsenic levels and tend to capture arsenic exposure over longer histories than other toxic chemicals.

"The whole idea that you would sue a winery for having arsenic in their wine is like suing someone for having rocks in their yard," Wilson said. "My goal is to get people away from asking the question 'who do we blame?' and instead offer consumers a better understanding of what they're ingesting and how they can minimize health risks that emerge from their diets."

Vitamin D3 supplementation helps women build muscle even after menopause

The benefits of vitamin D supplementation for postmenopausal women have been widely debated. But a new study from Sao Paulo, Brazil, now documents that vitamin D supplementation can significantly increase muscle strength and reduce the loss of body muscle mass in women as late as 12+ years after menopause. The study results will be presented at the 2015 Annual Meeting of The North American Menopause Society (NAMS), which begins September 30 in Las Vegas.

Vitamin D deficiency is a common problem in postmenopausal women worldwide, creating muscle weakness and a greater tendency for falling. The double-blind, placebo-controlled trial was conducted over a nine-month period. Muscle mass was estimated by total-body DXA (dual energy X-ray absorptiometry), as well as by handgrip strength and through a chair-rising test.

At the end of the trial, the women receiving the supplements demonstrated a significant increase (+25.3%) in muscle strength, while those receiving the placebo actually lost an average of 6.8% of muscle mass. Women not receiving Vitamin D supplements were also nearly two times as likely to fall.

"We concluded that the supplementation of Vitamin D alone provided significant protection against the occurrence of sarcopenia, which is a degenerative loss of skeletal muscle, says Dr. L.M. Cangussu, one of the lead authors of the study from the Botucatu Medical School at Sao Paulo State University.

"While this study is unlikely to decide the debate over Vitamin D, it provides further evidence to support the use of vitamin D supplements by postmenopausal women in an effort to reduce frailty and an increased risk of falling," says NAMS Executive Director Wulf H. Utian, MD, PhD, DSc(Med).

Over One Third of U.S. Adults Are Eligible to Receive Intensive Behavioral Counseling Services for Cardiovascular Disease Prevention

Today, September 29, is World Heart Day. In a new study published by the Centers for Disease Control and Prevention (CDC), researchers found that about one third of U.S. adults are eligible to receive covered services for intensive behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease (CVD) prevention.

The report used data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS).  Based on recommendations from the 2014 U.S. Preventive Services Task Force (USPSTF), respondents were defined as eligible for counseling services if they were overweight or obese and had one or more CVD risk factor (high blood pressure, high cholesterol, or impaired fasting glucose levels).

Among U.S. states and DC, the prevalence of eligibility ranged from 29.0% to 44.6%. It was also higher among men, black non-Hispanics, older adults, and in southern states. Researchers also found that of those eligible adults, over half did not meet the aerobic physical activity guideline as stated in the 2008 Physical Activity Guidelines for Americans.

Talk to Your Doctor About Your Eligibility for Cardiovascular Disease Prevention Counseling Services

Cardiovascular disease (CVD) is the leading cause of death in the United States. Health care professionals have a role in counseling patients about physical activity, which can help prevent CVD among persons with risk factors, such as hypertension, high cholesterol, or impaired fasting glucose.

Despite this, many health care professionals face barriers to providing related counseling services including a lack of time, limited patient receptiveness, lack of payment, and limited counseling experience or training. The Affordable Care Act’s (ACA) preventive services requirement might help lessen some of these barriers by requiring most health plans to cover evidence-based preventive services with a USPSTF rating of “A” or “B”. The USPSTF recommendation for intensive behavioral counseling for CVD prevention received a “B” rating, making it eligible for coverage and improving the potential for implementation.

The USPSTF recommendation and increased coverage by the ACA could benefit a third of the U.S adult population, especially those who did not meet the aerobic physical activity guideline. Continued monitoring of the recommendation’s target population and implementation, potential barriers, and impact on health behaviors and outcomes will help determine the impact of this recommendation on preventing CVD.

10 minutes of self-paced walking restores vascular function impaired by extended sitting

Researchers from the University of Missouri School of Medicine have found that when a person sits for six straight hours, vascular function is impaired -- but by walking for just 10 minutes after a prolonged period of sitting, vascular health can be restored.

"It's easy for all of us to be consumed by work and lose track of time, subjecting ourselves to prolonged periods of inactivity," said Jaume Padilla, Ph.D., an assistant professor of nutrition and exercise physiology at the MU School of Medicine and lead author of the study. "However, our study found that when you sit for six straight hours, or the majority of an eight-hour work day, blood flow to your legs is greatly reduced. We also found that just 10 minutes of walking after sitting for an extended time reversed the detrimental consequences."

During the study, the researchers compared the vascular function of 11 healthy young men before and after a period of prolonged sitting. The findings indicated that blood flow in the popliteal -- an artery in the lower leg -- was greatly reduced after sitting at a desk for six hours. Researchers then had the participants take a short walk, and found that 10 minutes of self-paced walking could restore the impaired vascular function and improve blood flow.

"When you have decreased blood flow, the friction of the flowing blood on the artery wall, called shear stress, is also reduced," Padilla said. "Moderate levels of shear stress are good for arterial health, whereas low levels of shear stress appear to be detrimental and reduce the ability of the artery to dilate. Dilation is a sign of vascular health. The more the artery can dilate and respond to stimuli, the healthier it is."

Many workplaces are sedentary environments, and the researchers said it's important that people understand the effects of sitting on their vascular health. By breaking up desk time with a short walk, workers can offset the harm caused to vascular blood vessels.

"Studies have shown that sitting less can lead to better metabolic and cardiovascular health," Padilla said. "However, more research is needed to determine if repeated periods of reduced vascular function with prolonged sitting lead to long-term vascular complications."

Unsaturated fats, high-quality carbs lower risk of heart disease

 
 While eliminating saturated fats can improve heart health, a new study shows that it makes a difference which foods are used in their place. A study published today in the Journal of the American College of Cardiology shows that replacing saturated fats with unsaturated fats and high-quality carbohydrates has the most impact on reducing the risk of heart disease. When saturated fats were replaced with highly processed foods, there was no benefit.

Previous research looked at the association between consumption of saturated fatty acids and the risk of coronary heart disease, but did not specify the replacement for saturated fat - such as unsaturated fats or the type of dietary carbohydrate. This is one of the first studies to distinguish between polyunsaturated fatty acids, monounsaturated fatty acids, and carbohydrates from whole grains or refined starches and added sugars.

"Many physicians could benefit from more in-depth nutritional knowledge to help them counsel their patients on changing their dietary practices in a way that will impact their health. In particular, we found that when study participants consumed less saturated fats, they were replacing them with low-quality carbohydrates such as refined grains that are not beneficial to preventing heart disease," said Frank B. Hu, M.D., Ph.D., study author and professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health.

"Our findings suggest that when patients are making lifestyle changes to their diets, cardiologists should encourage the consumption of unsaturated fats like vegetable oils, nuts, and seeds, as well as healthy carbohydrates such as whole grains," Hu said.

Editor-in-Chief of the Journal of the American College of Cardiology, Valentin Fuster, M.D., Ph.D., FACC, further elaborated on the important role clinicians play in helping patients make healthy lifestyle choices. "All physicians and medical personnel who interact with patients should speak with them about the benefits of consuming unsaturated fats and healthy carbohydrates," Fuster said.

Researchers analyzed data from the Nurses' Health Study, a cohort of 121,701 female nurses enrolled in 1976, and the Health Professionals Follow-up Study, a cohort of 51,529 men enrolled in 1986. For this study, researchers followed 84,628 women and 42,908 men who were free of diabetes, cardiovascular disease and cancer and documented 7,667 incidents of coronary heart disease.

Participants provided information on diet, lifestyle, medical history, and newly diagnosed diseases through questionnaires at baseline and every two to four years for 24 to 30 years. The questionnaire asked how often and in what quantity specific foods had been consumed in the past year and to specify the types of fats or oil used for frying, baking and at the table. The questionnaire was validated against biomarkers of dietary fatty acids.

Researchers noted that participants generally replaced calories from saturated fatty acids with calories from low-quality carbohydrates -- such as white bread or potatoes -- rather than calories from unsaturated fats found in vegetable oils, nuts and seeds or high-quality carbohydrates like those in whole grains. Replacing 5 percent of energy intake from saturated fats with an equivalent intake from either polyunsaturated fats, monounsaturated fats, or carbohydrates from whole grains was associated with 25 percent, 15 percent, and 9 percent lower risk of coronary heart disease, respectively. However, replacing 5 percent of energy intake from saturated fats with carbohydrates from refined starches or sugars was not associated with either increased or decreased risk of coronary heart disease.

Examples of the kinds of changes that Hu said could result in reduced risk of heart disease:

• Cooking with healthy fats such as canola oil, olive oil or other vegetable oils instead of butter, lard, and hard margarine.
• Exchanging snacks like potato chips and cookies for peanuts, almonds and olives.
• Making sandwiches with a whole wheat bun, avocados and chicken breast instead of large amounts of cheese and processed meats.

Study limitations included the observational nature that did not allow the study to prove causality and self-reported diet questionnaires cannot be completely accurate. However, the authors stated that their results were broadly consistent with those from randomized clinical trials, and the diet questionnaire was validated against fatty acid biomarkers.

In an accompanying editorial, Robert A. Vogel, M.D., Cardiology Section at the Department of Veterans Affairs Medical Center in Denver, said, "Healthfulness clearly lies in the quality or type of both fat and carbohydrate."

The study and editorial are part of a comprehensive Population Health Promotion issue of the Journal of the American College of Cardiology focusing on issues that broadly impact public health and the prevention of cardiovascular disease and related conditions. Population health is a strategic priority of the American College of Cardiology, which recently brought together experts from around the world to address issues such as smoking and nutrition in the context of developing public health strategies for improving population health.

New research exposes the health risks of fructose and sugary drinks

There is compelling evidence that drinking too many sugar-sweetened beverages, which contain added sugars in the form of high fructose corn syrup or table sugar (sucrose), can lead to excess weight gain and a greater risk of developing type 2 diabetes and cardiovascular disease, according to a new review paper published today in the Journal of the American College of Cardiology.

The review--the most comprehensive review of the evidence on the health effects of sugar-sweetened beverages to date--also takes a closer look at the unique role fructose may play in the development of these conditions.

"Since we rarely consume fructose in isolation, the major source of fructose in the diet comes from fructose-containing sugars, sucrose and high fructose corn syrup, in sugar-sweetened beverages," according to Frank Hu, MD, PhD, Professor of Nutrition and Epidemiology at Harvard T.H. Chan School of Public Health and lead investigator of the paper. "Our findings underscore the urgent need for public health strategies that reduce the consumption of these drinks."

Sweeteners such as high fructose corn syrup, produced from corn starch, have been widely used in the U.S. as a low-cost alternative to sucrose in foods and beverages. While the consumption of sugar-sweetened beverages has decreased moderately in the past decade, they are still the single greatest source of added sugar intake in the U.S. diet. In fact, half of the U.S. population consumes these types of drinks every day, with one in four getting at least 200 calories per day from them and 5 percent consuming more than 500 calories per day, which is the equivalent of four cans of soda.

"This is particularly concerning as the research shows that consuming one or more sugar-sweetened beverages a day has been linked to greater weight gain and obesity in numerous published studies," said Hu. "Regular consumption of sugar-sweetened beverages can lead to weight gain because the liquid calories are not filling, and so people don't reduce their food intake at subsequent meals."

The paper, which reviewed data from recent epidemiological studies and meta-analyses of these studies, reveals that consuming one or two servings a day has been linked to:

1. as high as a 26 percent greater risk of developing type 2 diabetes,
2. a 35 percent greater risk of heart attack or fatal heart disease, and
3. a 16 percent increased risk of stroke

The research team also explored how fructose is metabolized in the body and its link to weight gain and the development of metabolic and cardiovascular conditions.

"Part of the problem is how fructose behaves in the body," said Hu. Glucose, another component of sugar, is readily absorbed from the gastrointestinal tract into the bloodstream where it is transported through the action of insulin into the body's cells to be used as fuel. Fructose, on the other hand, is metabolized in the liver where it can be converted to fatty compounds called triglycerides, which may lead to fatty liver disease and insulin resistance, a key risk factor for developing diabetes and cardiovascular disease. Overconsumption of fructose can also lead to too much uric acid in the blood, which is associated with a greater risk of gout, a painful inflammatory arthritis.

The researchers point out that since fructose and glucose typically travel together in sugar-sweetened beverages and foods, it is important to reduce total amounts of added sugars, especially in the form of sugar-sweetened beverages. They outline a number of alternatives to sugar-sweetened beverages that include water, coffee, and tea.

Hu says that while artificially sweetened drinks may be preferable to sugary drinks in the short-term, but further studies are needed to evaluate their long-term health effects.

Hu says additional research is needed to explore the health effects of different types of sugars and how liquid vs. solid forms of sugar affect the body. However, he says there is sufficient evidence to support the need for more aggressive public policy interventions to help reduce consumption of sugar-sweetened beverages. The World Health Organization and the 2015 U.S. Dietary Guidelines Advisory Committee recommend that added sugars comprise no more than 10 percent of total calories consumed.

"Although reducing the consumption of sugar-sweetened beverages or added sugar alone is unlikely to solve the obesity epidemic entirely, limiting intake is one simple change that will have a measurable impact on weight control and prevention of cardio-metabolic diseases," Hu and his team conclude.

Hu adds that he is hopeful that changes to nutritional labeling, which are expected to clearly define the amount of added sugar in a product and the percent daily value for added sugar, will also help to educate consumers and ultimately reduce the daily intake of these and other products packed with sugar.

The review paper is part of a comprehensive Population Health Promotion issue of the Journal of the American College of Cardiology focusing on issues that broadly impact public health and the prevention of cardiovascular disease and related conditions. Population health is a strategic priority of the American College of Cardiology, which recently brought together experts from around the world to address issues such as smoking and nutrition in the context of developing public health strategies for improving population health.

Aspirin use improves survival in all gastrointestinal cancers

Aspirin improves survival in patients with tumours situated throughout the gastrointestinal (GI) tract, results from a large study in The Netherlands show. This is the first time that survival data from patients with tumours in different GI locations have been analysed at the same time; previously, only one type of cancer, usually colorectal, was studied. The results of the study, involving nearly 14,000 patients, may lead to new insights regarding the use of aspirin in GI cancer say the researchers.

Presenting the results to the 2015 European Cancer Congress [1], the trial co-ordinator Martine Frouws, MD, from Leiden University Medical Centre, Leiden, The Netherlands, will describe how her team analysed data from 13,715 patients who had been diagnosed with a GI cancer between 1998 and 2011. By linking the data to drug dispensing information from PHARMO, the Institute for Drug Outcomes Research based in Utrecht, the team was able to show an association between aspirin use after a cancer diagnosis and overall survival (OS); they found there was a significant increase in OS among patients who did take aspirin compared to those who did not.

In total, 30.5% of patients used aspirin pre-diagnosis, 8.3% were solely post-diagnosis users, and 61.1% had not taken aspirin at all. The commonest sites for tumours were colon (42.8% of patients), rectum (25.4%), and esophagus (10.2%). Median follow-up time for all patients was 48.6 months, with 28% of patients surviving for at least five years. Patients using aspirin after their diagnosis had a chance of survival twice as high than that of those who did not use it in the same circumstances. The beneficial effect of aspirin use on survival was seen in patients with GI tumours after adjusting for potential confounding factors such as sex, age, stage of cancer, surgery, radiotherapy, chemotherapy and other medical conditions or disorders. [

"In most observational studies an 'intention to treat' method (once an aspirin user, always an aspirin user) is used for analysing aspirin's effect. In this study we analysed each separate prescription per patient, and therefore we were able to achieve a more exact estimate of the effect of aspirin on cancer survival. Now we would like to analyse tumour material from these patients to try and discover which ones would benefit from aspirin treatment. Through studying the characteristics of tumours in patients where aspirin was beneficial, we should be able to identify patients who could profit from such treatment in the future," Dr Frouws will say

At present, a multicentre, randomised, placebo-controlled trial is investigating the effect of a daily dose of 80 mg aspirin on OS of elderly patients with colon cancer in The Netherlands. The researchers hope that they will then be able to expand the trial to include further sites in the GI tract, and provide convincing proof that more patients will benefit from aspirin treatment. "Given that aspirin is a cheap, off-patent drug with relatively few side-effects, this will have a great impact on healthcare systems as well as patients," says Dr Frouws.

The scientists believe that the beneficial effect of aspirin in cancer is due to its antiplatelet effect. Platelets are a blood component whose function is to stop bleeding by clumping and clogging blood vessel injuries. Circulating tumour cells (CTCs) are thought to hide themselves from the immune system with the help of the clothing of platelets that surround them. Aspirin inhibits platelet function and therefore allows the immune system to recognise CTCs and eliminate them.
"Medical research is focusing more and more on personalised medicine," Dr Frouws will say, "but many personalised treatments are expensive and only useful in small populations. We believe that our research shows quite the opposite -- it demonstrates the considerable benefit of a cheap, well-established and easily obtainable drug in a larger group of patients, while still targeting the treatment to a specific individual."

Professor Peter Naredi, the ECCO scientific co-chair of the Congress, who was not involved in the research, commented: "We have good evidence that the frequent use of aspirin in the population can prevent some cases of colorectal cancer. Now, Dr Frouws and colleagues show that in over 13,000 patients who were diagnosed with a gastrointestinal cancer, aspirin also improved survival compared with those who did not use it. With more and more data to support the beneficial role of aspirin, we must consider whether we should recommend it to a wider public."

ESMO spokesperson, Professor Nadir Arber, MD, Head of the Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Center, Israel, who was not involved in the research, said: "Aspirin may serve as the magic bullet because it can target and prevent ischaemic heart disease, cancer and Alzheimer's disease, the three major health catastrophes in the third millennium.

"Dr Frouws and her colleagues tell us that not only can aspirin prevent disease, but low dose aspirin is important as an adjunct therapy for gastrointestinal cancers. The appropriate dosage and duration of aspirin use and risk/benefit ratios of aspirin use remain to be determined but, in the area of precision medicine, genetic information and blood and/or urinary biomarkers may help in tailoring treatment to those who will benefit most, while limiting adverse effects."

Some forms of dizziness after getting up may signal bigger problems

People who get dizzy several minutes after standing up may be at risk of more serious conditions and even an increased risk of death, according to new research published in the September 23, 2015, online issue of Neurology®, the medical journal of the American Academy of Neurology. Feeling dizzy, faint or light-headed after standing due to a sudden drop in blood pressure can be a minor problem due to medication use or dehydration. But when it happens often, it can be a sign of a more serious condition called orthostatic hypotension, which is defined as a drop in blood pressure within three minutes of sitting or standing.

"Our study looked at delayed orthostatic hypotension, when the drop in blood pressure happens more than three minutes after standing or sitting up," said study author Christopher Gibbons, MD, with Harvard Medical School in Boston and a Fellow with the American Academy of Neurology. "Our findings suggest that more than half of people with the delayed form of this condition will go on to develop the more serious form of this disease. This is also the first study to date suggesting the disease is a milder form of the more common and serious disorder."

For the study, researchers reviewed the medical records of 165 people with an average age of 59 who completed nervous system testing and were followed for 10 years. Of those, 48 were diagnosed with delayed orthostatic hypotension, 42 had orthostatic hypotension and 75 did not have either condition.

The study found that over 10 years, 54 percent of participants with delayed orthostatic hypotension progressed to orthostatic hypotension and 31 percent developed a degenerative brain disease such as Parkinson's or dementia with Lewy bodies.

The rate of death over 10 years was 29 percent for people with delayed orthostatic hypotension, 64 percent for those with orthostatic hypotension (the more serious form of the disease) and 9 percent in people without either condition. The death rate over 10 years for those with the delayed condition who progressed to orthostatic hypotension was 50 percent.

People with delayed orthostatic hypotension who also had diabetes at the beginning of the study were more likely to develop the full condition than those without diabetes.

Many of the people with the delayed condition that did not develop the full condition were taking medications that may have affected their blood pressure, such as diuretics, antidepressants and high blood pressure drugs.

"Our findings may lead to earlier recognition, diagnosis and treatments of this condition and possibly other underlying diseases that may contribute to early death," said Gibbons.

Gibbons said limitations of the study included that it was a retrospective review of data collected earlier and that participants were all referred to a specialized center for tests of the autonomic nervous system and may not reflect the overall community.

If you're sitting down, don't sit still, new research suggests

New research suggests that the movements involved in fidgeting may counteract the adverse health impacts of sitting for long periods.

In a study published today in the American Journal of Preventive Medicine, a team of researchers, co-led by the University of Leeds and UCL, report that an increased risk of mortality from sitting for long periods was only found in those who consider themselves very occasional fidgeters.

They found no increased risk of mortality from longer sitting times, compared to more active women, in those who considered themselves as moderately or very fidgety.

The study examined data from the University of Leeds' UK Women's Cohort Study, which is one of the largest cohort studies of diet and health of women in the UK.

Study co-lead author Professor Janet Cade, from the School of Food Science and Nutrition at the University of Leeds said: "While further research is needed, the findings raise questions about whether the negative associations with fidgeting, such as rudeness or lack of concentration, should persist if such simple movements are beneficial for our health."

Even among adults who meet recommended physical activity levels and who sleep for eight hours per night, it is possible to spend the vast majority of the day (up to 15 hours) sitting down.

The study builds on growing evidence suggesting that a sedentary lifestyle is bad for your health, even if you are physically active outside work.

Breaks in sitting time have previously been shown to improve markers of good health, such as body mass index and your body's glucose and insulin responses. But until now, no study has ever examined whether fidgeting might modify an association between sitting time and death rates.

The University of Leeds' UK Women's Cohort Study gathered information on a wide range of eating patterns of more than 35,000 women aged 35 to 69 who are living in the UK.

The new study analyses data from a follow-up survey sent to the same women, which included questions on health behaviours, chronic disease, physical activity levels and fidgeting. More than 14,000 responses were received.

Study co-lead author Dr Gareth Hagger-Johnson from UCL, who conducted the data analysis, said: "Our results support the suggestion that it's best to avoid sitting still for long periods of time, and even fidgeting may offer enough of a break to make a difference."

Investigation questions expert advice underpinning new US dietary guidelines

The expert report underpinning the latest dietary guidelines for Americans fails to reflect much relevant scientific literature in its reviews of crucial topics and therefore risks giving a misleading picture, an investigation by The BMJ has found.

Concern about the report has prompted the US Congress to schedule a hearing on the guidelines in October, when two cabinet secretaries are scheduled to testify, writes journalist Nina Teicholz in an article published today.

The guidelines will affect the diet of tens of millions of American citizens, as well as food labelling, education and research priorities. In the past, most Western nations have adopted similar dietary advice. They are based on a report produced by an advisory committee - a group of 14 experts appointed to review the best and most current science to make nutrition recommendations that both promote health and fight disease.

The previous committee in 2010 made an effort to bring greater scientific rigor to the process by using the Nutrition Evidence Library (NEL), set up by the US Department of Agriculture (USDA), to help conduct reviews.

But the 2015 committee has not used NEL methods for the majority of its analyses, notes Teicholz. Instead it relies heavily on systematic reviews from professional bodies, such as the American Heart Association and the American College of Cardiology, who are supported by food and drug companies.

The committee members, who are not required to list their potential conflicts of interest, also conducted 'ad hoc' reviews of the literature, without any systematic criteria for how studies were identified, selected, or evaluated, she adds.

On saturated fats, for example, the committee did not conduct a formal review of the literature from the past five years, even though several prominent papers published since 2010 failed to confirm any association between saturated fats and heart disease. Despite a great deal of conflicting evidence over the past five years, the committee's report concludes that the evidence linking consumption of saturated fats to cardiovascular disease is "strong."

On the effectiveness of low carbohydrate diets, again, the committee did not request a NEL systematic literature review from the past five years, writes Teicholz. Yet dozens of randomised controlled clinical trials published since 2000 show that low carbohydrate diets are at least equal to if not better than other nutritional approaches for controlling type 2 diabetes, achieving weight loss in the short term, and improving most heart disease risk factors.

"Given the growing toll taken by these conditions and the failure of existing strategies to make meaningful progress in fighting obesity and diabetes to date, one might expect the guideline committee to welcome any new, promising dietary strategies," says Teicholz. Yet the committee largely sticks to the same advice it has given for decades - to eat less saturated fat (in meat and full-fat dairy products) and more plant foods for good health.

Abandoning established review methods "opens the door not only to potential bias but also for the possibility of influence from outside agendas and commercial interests, and all of these can be observed in the report," she observes. The prevailing bias, she adds, appears to be one to preserve the nutrition recommendations of the past 35 years.

Nevertheless, the report is highly confident that its findings are supported by good science.

Committee chair, Barbara Millen told The BMJ: "On topics where there were existing comprehensive guidelines, we didn't do them. We used those resources and that time to cover other questions," she explained. "That's why you have an expert committee . . . to bring expertise," including "our own original analyses."

On saturated fats, Millen said that her committee had "worked with the NEL and USDA assistance to identify the research literature." And on low carbohydrate diets, she said that there was "not substantial evidence" to consider. "Many popular diets don't have evidence. But can you achieve healthiness, the answer is yes."

Regarding the committee's conflicts of interest, she said that members were vetted by counsel to the federal government.

Yet given the ever increasing toll of obesity, diabetes, and heart disease, and the failure of existing strategies to make inroads in fighting these diseases, there is an urgent need to provide nutritional advice based on sound science, argues Teicholz.

"It may be time to ask our authorities to convene a fresh, truly independent panel of scientists free from potential conflicts to undertake a comprehensive review, in order to ensure that selection of the dietary guidelines committee becomes more transparent, and that the most rigorous scientific evidence is reliably used to produce the best possible nutrition policy," she concludes.

Dr Fiona Godlee, The BMJ's Editor in Chief adds: "These guidelines are hugely influential, affecting diets and health around the world. The least we would expect is that they be based on the best available science. Instead the committee has abandoned standard methodology, leaving us with the same dietary advice as before - low fat, high carbs.

Growing evidence suggests that this advice is driving rather than solving the current epidemics of obesity and type 2 diabetes. The committee's conflicts of interest are also a concern. We urgently need an independent review of the evidence and new thinking about diet and its role in public health."

Women with moderate beer consumption run lower risk of heart attack

Women who drink beer at most once or twice per week run a 30 per cent lower risk of heart attack, compared with both heavy drinkers and women who never drink beer. These are the findings of a Swedish study which has followed 1,500 women over a period of almost 50 years.

In the study, researchers at the Sahlgrenska Academy, University of Gothenburg, have followed a representative selection of the middle-aged female population from 1968 to 2000 (when the women in the study were between 70 and 92 years old).

Now, with the help of data from the study, the researchers have attempted to chart the relationship between the intake of different types of alcoholic beverages and the incidence of heart attacks, stroke, diabetes and cancer.

Beer consumption

In the study in question, the 1,500 women were asked about the frequency of their consumption of beer, wine or spirits (from 'daily' to 'nothing in the past 10 years'), and about various physical symptoms.

The results reveal that over the 32-year follow-up period, 185 women had a heart attack, 162 suffered a stroke, 160 developed diabetes and 345 developed cancer.

Higher cancer risk

The study shows a statistically significant connection between high consumption of spirits (defined as more frequent than once or twice per month) and an almost 50 per cent higher risk of dying of cancer, compared with those who drink less frequently.

Lower risk of heart attack

The study also reveals that women who reported that they drank beer once or twice per week to once or twice per month ran a 30 per cent lower risk of a heart attack than women who drank beer several times per week/daily or never drank beer. Moderate consumption of beer thus seems to protect women from heart attacks.

"Previous research also suggests that alcohol in moderate quantities can have a certain protective effect, but there is still uncertainty as to whether or not this really is the case. Our results have been checked against other risk factors for cardiovascular disease, which substantiates the findings. At the same time, we were unable to confirm that moderate wine consumption has the same effect, so our results also need to be confirmed through follow-up studies," explains Dominique Hange, researcher at Sahlgrenska Academy.

The article A 32-year longitudinal study of alcohol consumption in Swedish women: Reduced risk of myocardial infarction but increased risk of cancer was published online in Scandinavian Journal of Primary Health Care in July 2015.

Eating more fruits and non-starchy vegetables is associated with less weight gain

Increased consumption of fruits and non-starchy vegetables is inversely associated with weight change, according to a study published this week in PLOS Medicine. The longitudinal study, conducted by Monica Bertoia of Harvard T. H. Chan School of Public Health and Brigham & Women's Hospital, Boston, Massachusetts, and colleagues, shows differences by type of fruit or vegetable, suggesting that characteristics of these foods influence the strength of their association with weight change.

The 2010 Dietary Guidelines for Americans recommend that adults and children should eat a variety of fruits and vegetables to help them achieve and maintain a healthy weight. In this study, Bertoia and colleagues examined associations between changes in the intake of specific fruits and vegetables recorded in dietary questionnaires and self-reported weight changes in 133,468 US men and women followed for up to 24 years in the Nurses' Health Study, Health Professionals Follow-up Study and Nurses' Health Study II.

After adjusting for self-reported changes in other lifestyle factors such as smoking status and physical activity, an increased intake of fruits and of several vegetables was inversely associated with 4-y weight change (-0.53 lb (- 0.24 kg) for each extra daily serving of fruit, -0.25 lb (-0.11 kg) for vegetables). However, starchy vegetables, for example peas (1.13 lb; 95% CI 0.37 to 1.89 lb) and corn (2.04 lb; 95% CI 0.94 to 3.15 lb), were associated with weight gain.

These findings may not be generalizable--nearly all the participants were well-educated white adults, and the use of dietary questionnaires and self-reported weight measurement may have introduced measurement errors. However, study strengths include a very large sample size and long follow-up, with consistent results across three cohorts. The authors state, "our findings support benefits of increased fruit and vegetable consumption for preventing long-term weight gain and provide further food-specific guidance for the prevention of obesity, a primary risk factor for type 2 diabetes, cardiovascular diseases, cancers, and many other health conditions."

Sex does not increase heart attack risk

Sex is rarely the cause of a heart attack, and most heart disease patients are safe to resume sexual activity after a heart attack, according to a research letter published today in the Journal of the American College of Cardiology.
Sexual activity can be a concern for many heart attack patients who worry about exertion triggering another heart event, but data on the harms and benefits of sexual activity in heart disease patients is limited. According to the research letter, sexual activity generally involves moderate physical activity comparable to climbing two staircases or taking a brisk walk.

Researchers looked at 536 heart disease patients between 30 and 70 years old to evaluate sexual activity in the 12 months before a heart attack and estimate the association of frequency of sexual activity with subsequent cardiovascular events, including fatal heart attack, stroke or cardiovascular death.

In a self-reported questionnaire, 14.9 percent of patients reported no sexual activity in the 12 months before their heart attack, 4.7 percent reported sex less than once per month, 25.4 percent reported less than once per week and 55 percent reported one or more times per week. During 10 years of follow up, 100 adverse cardiovascular events occurred in patients in the study. Sexual activity was not a risk factor for subsequent adverse cardiovascular events.

Researchers also evaluated the timing of the last sexual activity before the heart attack. Only 0.7 percent reported sex within an hour before their heart attack. In comparison, over 78 percent reported that their last sexual activity occurred more than 24 hours before the heart attack.

"Based on our data, it seems very unlikely that sexual activity is a relevant trigger of heart attack," said Dietrich Rothenbacher, M.D., M.P.H., lead author of the study and professor and chair of the Institute of Epidemiology and Medical Biometry at Ulm University in Ulm, Germany. "Less than half of men and less than a third of women are getting information about sexual activity after heart attack from their doctors. It is important to reassure patients that they need not be worried and should resume their usual sexual activity."

Researchers said that despite the benefits of sexual activity outweighing risks, the potential of erectile dysfunction as a side effect from various cardiovascular protective medications and the risk of a drop in blood pressure from combining certain heart medications with erectile dysfunction medications should be clearly communicated to patients.

The Effects of Long-Term Exposure to Air Pollution on Mortality

There is strong evidence that short-run fluctuations in air pollution negatively impact infant health and contemporaneous adult health, but there is less evidence on the causal link between long-term exposure to air pollution and increased adult mortality. 

This project estimates the impact of long-term exposure to air pollution on mortality by leveraging quasi-random variation in pollution levels generated by wind patterns near major highways. 

The researchers find that doubling the percentage of time spent downwind of a highway increases mortality among individuals 75 and older by 3.6 to 6.8 percent. 

Tai Chi linked to improved physical capacity in certain common long term conditions

The ancient Chinese exercise Tai Chi is linked to improved physical capacity among older adults with certain common long term conditions, indicates a pooled analysis of the available evidence, published online in the British Journal of Sports Medicine.

Among people with breast cancer, heart failure, osteoarthritis and chronic obstructive pulmonary disease (COPD), these improvements were not at the expense of worsening pain or breathlessness, the findings show.

Tai Chi consists of slow, gentle, flowing movements that aim to boost muscle power, balance, and posture. It also includes mindfulness, relaxation, and breath control.

The researchers wanted to find out how effective Tai Chi was in long term conditions that are common among older adults. So they trawled electronic research databases for relevant studies published up to 2014, on the use of Tai Chi in people with cancer, osteoarthritis, heart failure, and COPD.

They wanted to find out if Tai Chi relieved symptoms, and improved physical capacity and quality of life in all four long term conditions.

Out of 1102 articles, 33, involving 24 studies and 1584 participants, were suitable for inclusion; 21 studies were included in the pooled analysis.

The average age of participants ranged from the mid 50s to the early 70s, while the average length of the Tai Chi training programme was 12 weeks, with most sessions lasting an hour. Tai Chi training was usually offered two to three times weekly.

The results showed that Tai Chi was associated with trends, or definite improvement, in physical capacity and muscle strength in most or all four long term conditions.

This included improvements in the six minute walking test; muscle strength, as measured by bending and stretching the knees; the time it takes to get up and move known as the TUG test; and quality of life.

Tai Chi was also associated with an improvement in the symptoms of pain and stiffness in osteoarthritis and in breathlessness in COPD. And it was associated with improved sit to stand times among patients with osteoarthritis.

This is an observational study so no definitive conclusions can be drawn about cause and effect, added to which the only cancer included in the analysis was breast cancer.

But the findings back those of previous research, and provide a reasonable starting point to look at the value of exercise programmes, such as Tai Chi, for people with several co-existing long term conditions, say the researchers.

"Tai Chi can improve some physical performance outcomes in four chronic conditions...but not at the expense of worsening pain or dyspnoea [breathlessness]," they write, adding that it "may provide a suitable exercise stimulus for people with several comorbidities," and could be used as a complementary therapy in some long term conditions.

Excessive daytime sleepiness and long naps linked to increased diabetes risk

New research presented at this year's annual meeting of the European Association for the Study of Diabetes (EASD) shows that daytime sleepiness and taking long naps during the day are both associated with an increased risk of type 2 diabetes. The research is by Dr Tomohide Yamada, University of Tokyo, Japan.

Sleep is an important component of a healthy life, along with a good diet and appropriate physical activity. Excessive daytime sleepiness is widely prevalent around the world, as is the habit of taking short sleeps or "napping". Daytime naps are usually brief, but can range from a few minutes to a few hours. The frequency varies from taking an occasional nap to planned rest periods several times daily for habitual nappers. Some individuals take a nap because they are excessively sleepy during the daytime as a result of a sleep disorder.

In this new study, the authors did a meta-analysis to investigate the association between daytime sleepiness or napping and the risk of type 2 diabetes. They searched Medline, the Cochrane Library, and Web of Science for articles published up to November 2014 using the keywords daytime sleepiness, nap, and diabetes. Among 683 studies initially identified, a total of 10 were deemed of good quaility and included 261,365 Asian and Western subjects. The studies came from Sweden, Spain, Finland, and Germany (daytime sleepiness) and the USA, China and Germany (napping). Excessive daytime sleepiness was defined as answering yes to questions like "Do you have a problem with sleepiness during the daytime?". Daytime napping was defiened on the basis of answering yes to questions such as "Do you take a daytime nap?" or "Do you sleep during the day?".

Excessive daytime sleepiness was found to increase the risk of diabetes by 56%, while a longer daytime nap of 60 minutes or more increased the risk by 46%. In contrast, a shorter nap (60 mins or less per day) did not increase the risk of diabetes. The analysis showed there was no effect of napping up to about 40 minutes per day, after which risk began to increase sharply.

The authors conclude: "Excessive daytime sleepiness and taking longer naps were associated with increased risk of type 2 diabetes, with a short nap not increasing this risk."

They add: "Daytime napping might be a consequence of night-time sleep disturbance such as obstructive sleep aponea (OSA). Epidemiological studies have shown that obstructive sleep apnoea is independently linked to blockages (ischaemia) of heart arteries, stroke, fatal and non-fatal cardiovascular events, and all-cause mortality. "

They explain further: "Several studies have demonstrated the beneficial effects of taking short naps less than 30 minutes in duration, which help to increase alertness and motor skills. A short nap finishes before the onset of deep slow-wave sleep. Entering deep slow-wave sleep and then failing to complete the normal sleep cycle can result in a phenomenon known as sleep inertia, in which a person feels groggy, disoriented, and even sleepier than before napping. Although the mechanisms by which a short nap might decrease the risk of diabetes are still unclear, such duration-dependent differences in the effects of sleep might partly explain our findings."

Beetroot juice improves sprinting and decision-making during exercise

Drinking high nitrate beetroot juice improves both sprint performance and decision-making during prolonged intermittent exercise such as rugby and football (soccer), according to scientists from the University of Exeter.

The research, published in the European Journal of Applied Physiology and available on PubMed, adds further weight to the case for beetroot juice as a superfood for elite both elite and amateur sports players and athletes. Previously, the team at Exeter has regular beetroot juice drinks can help people to exercise for 16% longer.

In the latest study,16 male team sport players received 140ml of Beet It Sport, high nitrate beetroot juice* for seven days.

On day seven, the sportsmen, who were all members of rugby, hockey or football teams, completed an intermittent sprint test which consisted of two 40 minute sessions of repeated two minute blocks. This consisted of a six second all-out sprint, 100 seconds active recovery and 20 seconds of rest, on an exercise bike. At the same time, they were given cognitive tasks designed to test how accurately and how fast they made decisions.

The participants carried out the same tests after drinking nitrate-rich beetroot juice and again after drinking a placebo version with the nitrate stripped out. Researchers found those who had consumed the nitrate-rich version saw an improvement in both sprint performance (3.5%) and speed of making decisions (3%) without hindering decision accuracy.

Chris Thompson, of the University of Exeter, who led the study, said: "This research is a really exciting landmark in the work conducted on nitrate supplementation so far. The improvement we found may seem small, but it's likely to provide a meaningful advantage to the athlete on the sports field. It could mean that team sport players are able to make those important decisions faster and cover more ground than their opponents in the seconds when it matters most."

Professor Andrew Jones PhD, Associate Dean for Research at the College of Life and Environmental Sciences, University of Exeter commented: "These new results suggest that beetroot juice could improve both physical performance and decision-making during team sports such as rugby and football".

BEET IT shots are at the centre of worldwide research in over 150 universities into the benefits of natural dietary nitrate supplementation. The research has identified that their naturally high dietary nitrate content (400mg per shot) interacts with enzymes in saliva to generate nitric oxide in the blood system. Nitric oxide is a vasodilator that increases the flow of blood and oxygen to the muscles, thereby boosting strength and endurance.

Birth control pills pose small but significant stroke risk

Birth control pills cause a small but significant increase in the risk of the most common type of stroke, according to a comprehensive report in the journal MedLink Neurology.

For healthy young women without any stroke risk factors, the risk of stroke associated with oral contraceptives is small. But in women with other stroke risk factors, "the risk seems higher and, in most cases, oral contraceptive use should be discouraged," report co-authors Marisa McGinley, DO; Sarkis Morales-Vidal, MD; and Jose Biller, MD of Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine.

Worldwide, more than 100 million women currently use oral contraceptives or have used them in the past. In the United States, there are about 40 brands of oral contraceptives and 21 brands of emergency contraceptive pills.

Strokes associated with oral contraceptives were first reported in 1962. Early versions of the pill contained doses of synthetic estrogen as high as 150 micrograms. Most birth control pills now contain as little as 20 to 35 micrograms. None contain more than 50 micrograms of synthetic estrogen.

Oral contraceptives increase the risk of ischemic strokes, which are caused by blood clots and account for about 85 percent of all strokes. In the general population, oral contraceptives do not appear to increase the risk of hemorrhagic strokes, which are caused by bleeding in the brain.

There are about 4.4 ischemic strokes for every 100,000 women of childbearing age. Birth control pills increase the risk 1.9 times, to 8.5 strokes per 100,000 women, according to a well-performed "meta-analysis" cited in the report. (A meta-analysis combines the results of multiple studies.) This is still a small risk; 24,000 women would have to take birth control pills to cause one additional stroke, according to the report.

But for women who take birth control pills and also smoke, have high blood pressure or have a history of migraine headaches, the stroke risk is significantly higher. Such women should be discouraged from using oral contraceptives, the report said.

Hormone replacement therapy with estrogen alone or combined with progesterone increases the risk of ischemic stroke by 40 percent; the higher the dose, the higher the risk, the report said.

Beef vs. bean meals: Both provide similar feeling of fullness

Today vegetarians aren't the only group of consumers looking for foods that are meat-free and provide a satisfying meal. All types of consumers are looking to manage and maintain weight with plant-based meal options with ingredients such as protein isolates, whole legumes, whole grains and vegetables. A new study in the Journal of Food Science, published by the Institute of Food Technologists (IFT), found that a bean-based meal provided a similar feeling of fullness compared to a beef-based meal.

Researchers from the University of Minnesota had 28 participants (14 men and 14 women) consume two test lunches containing a "meatloaf" made from either beef or beans. The beef meal provided 26 grams of protein and three grams of fiber, while the bean meal provided 17 grams of protein and 12 grams of fiber. Both meals were matched in weight, calories, and total fat. All the participants showed no difference in appetite ratings between the beef and bean meals over three hours. In addition they consumed the same amount of calories at the next meal eaten.

Protein is considered to be the number one nutrient that induces the feeling of fullness, with fiber coming in a close second. While protein intake releases appetite suppressing hormones, the beneficial effects of fiber on appetite and food include slowing down the digestion process and helping control blood sugar levels to increase the feeling of fullness for longer. The findings of this study support the idea that plant-based proteins with high fiber may offer similar appetite regulation as animal protein.

Exercise fights suicidal tendencies in bullied students

A study to be published in the October 2015 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) reports that exercise for 4 or more days per week is associated with an approximate 23% reduction in both suicidal ideation and attempt in bullied adolescents in the U.S.

Across the U.S., nearly 20% of students report being bullied on school property. Bullying is associated with academic struggle, low self-esteem, anxiety, depression, substance abuse, and self-harm. Exercise has been widely reported to have robust positive effects on mental health including reduction in depression, anxiety, and substance abuse.

Using data from a nationally representative sample of youth who participated in the National Youth Risk Behavior Survey (CDC), a group of researchers led by Dr. Jeremy Sibold of the University of Vermont, examined the relationship between exercise frequency, sadness, and suicidal ideation and attempt in 13,583 U.S. adolescents in grades 9-12. The authors hypothesized that exercise frequency would be inversely related to sadness and suicidality and that these benefits would extend to bullying victims.

Overall, 30% of students studied reported sadness for 2 or more weeks in the previous year; 22.2% and 8.2% reported suicidal ideation and suicidal attempt in the same time period. Bullied students were twice as likely to report sadness, and three times as likely to report suicidal ideation or attempt when compared to peers who were not bullied.

Exercise on 4 or more days per week was associated with significant reductions in sadness, suicidal ideation, and suicidal attempt in all students. In particular, the data showed a startling 23% reduction in both suicidal ideation and suicidal attempt in bullied students who exercised 4 or more days per week.

Based on these findings, the authors concluded that exercise may represent a safe, economical, and potentially highly effective option in the response to bullying in schools. Bullying is a severe and growing public health burden with consequences reported across the life span. More research is necessary to further define the mechanisms behind these findings as well as the role that exercise can play in reducing the often severe mental health consequences for victims. Further, the paper raises the possibility of exercise programs as a public health approach to reduce suicidal behavior in all adolescents. This is particularly important consideration due to the fact that many high schools in our country have little or no exercise programs for non-varsity athletes.

Mediterranean diet, fruits and vegetable, prevent depression

Eating a Mediterranean diet or other healthy dietary pattern, comprising of fruit, vegetables, legumes, and nuts and low in processed meats, is associated with preventing the onset of depression, according to research published in the open access journal BMC Medicine. A large study of 15,093 people suggests depression could be linked with nutrient deficits.

Following extensive research into diet and its effect on our physical health, researchers are now exploring the link between nutrition and mental health. This is the first time that several healthy dietary patterns and their association with the risk of depression have been analyzed together.
The researchers compared three diets; the Mediterranean diet, the Pro-vegetarian Dietary Pattern and Alternative Healthy Eating Index-2010. Participants used a scoring system to measure their adherence to the selected diet, i.e. the higher the dietary score indicated that the participant was eating a healthier diet.

Food items such as meat and sweets (sources of animal fats: saturated and trans fatty acids) were negatively scored, while nuts, fruits and vegetables (sources of omega-3 fatty acids, vitamins and minerals respectively) were positively scored.

Lead researcher, Almudena Sanchez-Villegas, University of Las Palmas de Gran Canaria, says "We wanted to understand what role nutrition plays in mental health, as we believe certain dietary patterns could protect our minds. These diets are all associated with physical health benefits and now we find that they could have a positive effect on our mental health."

"The protective role is ascribed to their nutritional properties, where nuts, legumes, fruits and vegetables (sources of omega-3 fatty acids, vitamins and minerals) could reduce the risk of depression."

The study included 15,093 participants free of depression at the beginning of the study. They are former students of the University of Navarra, Spain, registered professionals from some Spanish provinces and other university graduates. All are part of the SUN (Seguimiento Universidad de Navarra) Project, a cohort study started on 21st December 1999. The cohort has been used to identify dietary and lifestyle determinants of various conditions, including diabetes, obesity and depression.
Questionnaires to assess dietary intake were completed at the start of the project and again after 10 years. A total of 1,550 participants reported a clinical diagnosis of depression or had used antidepressant drugs after a median follow-up of 8.5 years.

The Alternative Healthy Eating Index-2010 was associated with the greatest reduction of risk of depression but most of the effect could be explained by its similarity with the Mediterranean Diet. Thus, common nutrients and food items such as omega-3 fatty acids, vegetables, fruits, legumes, nuts and moderate alcohol intake present in both patterns (Alternative Healthy Eating Index-2010 and Mediterranean diet) could be responsible for the observed reduced risk in depression associated with a good adherence to the Alternative Healthy Eating Index-2010.

Almudena Sanchez-Villegas says, "A threshold effect may exist. The noticeable difference occurs when participants start to follow a healthier diet. Even a moderate adherence to these healthy dietary patterns was associated with an important reduction in the risk of developing depression. However, we saw no extra benefit when participants showed high or very high adherence to the diets.

So, once the threshold is achieved, the reduced risk plateaus even if participants were stricter with their diets and eating more healthily. This dose-response pattern is compatible with the hypothesis that suboptimal intake of some nutrients (mainly located in low adherence levels) may represent a risk factor for future depression."

A limitation of this study was that the results are based on self-reported dietary intake and a self-reported clinical diagnosis of depression. More research is needed to predict the role of nutrient intake for neurophysiological requirements and identify whether it is minerals and vitamins or proteins and carbohydrates that cause depression.

Antibacterial soap no more effective than plain soap at reducing bacterial contamination

Scientists have discovered that using antibacterial soap when hand-washing is no more effective than using plain soap, according to a paper published in the Journal of Antimicrobial Chemotherapy.

The study examined the effect of triclosan (the most commonly used active antiseptic ingredient used in soap) on bacteria in two ways. The first was to examine the bactericidal effects of triclosan in soaps against all 20 strains, and the second compared the ability of antibacterial and non-antibacterial soap to remove bacteria from human hands, by using 16 healthy adult volunteers. The results of the study indicate that there is no significant difference between the effects of plain soap and antibacterial soap when used under ‘real life’ conditions.

The scientists recreated the conditions of human hand washing by exposing the bacteria for 20 seconds at 22°C (room temperature) and 40°C (warm temperature) to triclosan with a concentration of 0.3% - the maximum allowed by law. There were significantly great effects after more than nine hours, but not during the short time required for hand washing.

Energy Drinks Linked to Brain Injuries

Teens who reported a traumatic brain injury in the past year were seven times more likely to have consumed at least five energy drinks in the past week than those without a history of TBI, according to a study published today in PLOS ONE.

Researchers also found that teens who reported sustaining a TBI within the past year were at least twice as likely to have consumed energy drinks mixed with alcohol than teens who reported sustaining a TBI more than a year previously.

"We've found a link between increased brain injuries and the consumption of energy drinks or energy drinks mixed with alcohol," said Dr. Michael Cusimano, a neurosurgeon at St. Michael's Hospital. "This is significant because energy drinks have previously been associated with general injuries, but not specifically with TBI."

Dr. Cusimano said energy drink consumption could interfere with recovery efforts for teens who have sustained a TBI. "Energy drinks, such a Red Bull and Rockstar, contain high levels of caffeine and change the chemical state of the body, which can prevent people from getting back on track after a TBI," said Dr. Cusimano. "Brain injuries among adolescents are particularly concerning because their brains are still developing."

At a time when energy drink consumption is rising among teens in Canada and the United States, the study also suggests that the caffeinated drinks are particularly linked with those who play sports.

"I think that energy drinks appeal to teens, especially athletes, because the drinks provide temporary benefits such as increased alertness, improved mood and enhanced mental and physical states," said Dr. Cusimano. "Advertisements for the drinks also often feature prominent athletes."

Teens who reported suffering a TBI in the past year while playing sports were twice as likely to consume energy drinks as teens who reported a TBI from other injuries in the same time period.

Data for the study was collected by the Centre for Addiction and Mental Health's 2013 Ontario Student Drug Use and Health Survey. Approximately 10,000 students ages 11 to 20 participated in the self-administered, in-classroom survey. TBI was defined as an injury resulting in the loss of consciousness for at least five minutes, or being hospitalized for at least one night.

"It is particularly concerning to see that teens who report a recent TBI are also twice as likely to report consuming energy drinks mixed with alcohol," said Dr. Robert Mann, senior scientist at the Centre for Addiction and Mental Health in Toronto and director of the OSDUHS. "While we cannot say this link is causal, it's a behaviour that could cause further injury and so we should be looking at this relationship closely in future research."

About 22 per cent of all students surveyed reported they'd experienced a TBI, with sports injuries accounting for almost half of TBI cases experienced in the past year.

Previous research at St. Michael's Hospital found that TBI is associated with poor academic performance, mental health issues, violence, substance abuse and aggression in both teens and adults -- factors that can interfere with rehabilitation, said Dr. Cusimano.

According to the new study, a better understanding of the link between TBI and energy drinks could help medical professionals, parents, teachers and coaches understand how to better prevent, diagnose and treat brain injuries.

Caffeine at night delays human circadian clock

It's no secret that slugging down caffeinated drinks in the evening can disrupt sleep.

But a new study led by the University of Colorado Boulder and the Medical Research Council's Laboratory of Molecular Biology in Cambridge, England shows for the first time that evening caffeine delays the internal circadian clock that tells us when to get ready for sleep and when to prepare to wake up. The research team showed the amount of caffeine in a double espresso or its equivalent three hours before bedtime induced a 40-minute phase delay in the roughly 24-hour human biological clock.

The study also showed for the first time how caffeine affects "cellular timekeeping" in the human body, said CU-Boulder Professor Kenneth Wright, who co-led the study with John O'Neill of the Medical Research Council's Laboratory of Molecular Biology (LMB) in Cambridge. While it has been known that caffeine influences circadian clocks of even primitive creatures like algae and fruit flies, the new study shows that the internal clocks in human cells can be impacted by caffeine intake.

"This is the first study to show that caffeine, the mostly widely used psychoactive drug in the world, has an influence on the human circadian clock," said Wright, a professor in CU-Boulder's Department of Integrative Physiology. "It also provides new and exciting insights into the effects of caffeine on human physiology."

A paper on the subject led by Wright and O'Neill is being published online in the Sept 16 issue of Science Translational Medicine.

For the study the team recruited five human subjects, three females and two males, who went though a double-blind, placebo-controlled 49-day protocol through CU-Boulder's Sleep and Chronobiology Laboratory, which is directed by Wright. The subjects were tested under four conditions: low light and a placebo pill; low light and the equivalent of a 200-milligram caffeine pill dependent on the subject's weight; bright light and a placebo pill; and bright light and the caffeine pill.

Saliva samples of each participant were tested periodically during the study for levels of the hormone melatonin, which is produced naturally by the pineal gland when directed to do so by the brain's "master clock." The master clock is re-set by exposure to light and coordinates cellular clocks throughout the human body. Melatonin levels in the blood increase to signal the onset of biological nighttime during each 24-hour period and decrease at the start of biological daytime, said Wright.

Those who took the caffeine pill under low-light conditions were found to have a roughly 40-minute delay in their nightly circadian rhythm compared to those who took the placebo pill under low light conditions, said Wright. The magnitude of delay from the caffeine dose was about half that of the delay induced in test subjects by a three-hour exposure to bright, overhead light that began at each person's normal bedtime.

The study also showed that bright light alone and bright light combined with caffeine induced circadian phase delays in the test subjects of about 85 minutes and 105 minutes respectively. There were no significant differences between the dim light/caffeine combination and the bright light/placebo combination. Nor were there significant differences between the bright light/placebo and bright light/caffeine combinations. The results may indicate a "ceiling" was reached in the phase delay of the human circadian clock due to the external factors, Wright said.

In addition, researchers at O'Neill's lab at the LMB in Cambridge used "reporter" genes that made cells glow when the clock genes were expressed to measure changes caused by caffeine. O'Neill's group showed that caffeine can block cell receptors of the neurotransmitter adenosine, which normally promotes sleep and suppresses arousal.

The results may help to explain why caffeine-drinking "night owls" go to bed later and wake up later and may have implications for the treatment of some circadian sleep-wake disorders, said Wright.

The new results could benefit travelers. Properly timed caffeine use could help shift the circadian clocks of those flying west over multiple time zones, said Wright.

In a 2013 study, Wright and his research team showed one week of camping in the Rocky Mountains with no artificial light, not even flashlights, synchronized the circadian clocks of the eight study subjects with the timing of sunrise and sunset.

Eating a lot of fish may help curb depression risk

Eating a lot of fish may help curb the risk of depression--at least in Europe--suggests a pooled analysis of the available evidence, published online in the Journal of Epidemiology & Community Health.

The association between a fishy diet and mental health appears to be equally significant among men and women, the first analysis of its kind indicates.

Depression affects an estimated 350 million people worldwide, and is projected to become the second leading cause of ill health by 2020.

Several previous studies have looked at the possible role of dietary factors in modifying depression risk, but the findings have been inconsistent and inconclusive.

The researchers therefore pooled the data from relevant studies published between 2001 and 2014 to assess the strength of the evidence on the link between fish consumption and depression risk

After trawling research databases, they found 101 suitable articles, of which 16 were eligible for inclusion in the analysis. These 16 articles included 26 studies, involving 150, 278 participants.

Ten of the studies were cohort studies, which involve monitoring a group of people who don't have the condition in question for a period of time to see who develops it. The remainder were cross-sectional: these look at the association between a condition and other variables of interest in a defined population at a single point in time or over a brief period.

Ten of the studies involved participants from Europe; 7 those from North America; the rest involved participants in Asia, Oceania, and South America.

After pooling all the data together, a significant association emerged between those eating the most fish and a 17% reduction in depression risk compared with those eating the least. This was found in both cohort and cross-sectional studies, but only for the European studies.

When the researchers looked specifically at gender, they found a slightly stronger association between high fish consumption and lowered depression risk in men (20%). Among women, the associated reduction in risk was 16%.

This is an observational study so no definitive conclusions can be drawn about cause and effect, added to which fish consumption was measured using different dietary assessment methods across the various studies. But there may be a plausible biological explanation for the link, suggest the researchers.

For example, it has been suggested that the omega 3 fatty acids found in fish may alter the microstructure of brain membranes and modify the activity of the neurotransmitters, dopamine and serotonin, both of which are thought to be involved in depression.

Furthermore, the high quality protein, vitamins, and minerals found in fish may help stave off depression, while eating a lot of fish may be an indicator of a healthy and more nutritious diet, suggest the researchers.

"Higher fish consumption may be beneficial in the primary prevention of depression," they conclude, adding: "Future studies are needed to further investigate whether this association varies according to the type of fish."

Resveratrol impacts Alzheimer's disease biomarker

The largest nationwide clinical trial to study high-dose resveratrol long-term in people with mild to moderate Alzheimer's disease found that a biomarker that declines when the disease progresses was stabilized in people who took the purified form of resveratrol.

Resveratrol is a naturally occurring compound found in foods such as red grapes, raspberries, dark chocolate and some red wines.

The results, published online in Neurology, "are very interesting," says the study's principal investigator, R. Scott Turner, MD, PhD, director of the Memory Disorders Program at Georgetown University Medical Center. Turner, who treats patients at MedStar Georgetown University Hospital, cautions that the findings cannot be used to recommend resveratrol. "This is a single, small study with findings that call for further research to interpret properly."

The resveratrol clinical trial was a randomized, phase II, placebo-controlled, double blind study in patients with mild to moderate dementia due to Alzheimer's disease. An "investigational new drug" application was required by the U.S. Food and Drug Administration to test the pure synthetic (pharmaceutical-grade) resveratrol in the study. It is not available commercially in this form.

The study enrolled 119 participants. The highest dose of resveratrol tested was one gram by mouth twice daily -- equivalent to the amount found in about 1,000 bottles of red wine.

John Bozza, 80, participated in the study. Five years ago, his wife, Diana, began noticing "something wasn't quite right." He was diagnosed with mild cognitive impairment, but only a year later, his condition progressed to mild Alzheimer's.

Diana, whose twin sister died from the same disease, says there are multiple reasons she and John decided to participate in the resveratrol study, and they now know he was assigned to take the active drug.

"I definitely want the medical community to find a cure," she says. "And of course I thought there's always a chance that John could have been helped, and who knows, maybe he was."

Patients, like John, who were treated with increasing doses of resveratrol over 12 months showed little or no change in amyloid-beta40 (Abeta40) levels in blood and cerebrospinal fluid. In contrast, those taking a placebo had a decrease in the levels of Abeta40 compared with their levels at the beginning of the study.

"A decrease in Abeta40 is seen as dementia worsens and Alzheimer's disease progresses; still, we can't conclude from this study that the effects of resveratrol treatment are beneficial," Turner explains. "It does appear that resveratrol was able to penetrate the blood brain barrier, which is an important observation. Resveratrol was measured in both blood and cerebrospinal fluid."

The researchers studied resveratrol because it activates proteins called sirtuins, the same proteins activated by caloric restriction. The biggest risk factor for developing Alzheimer's is aging, and studies with animals found that most age-related diseases--including Alzheimer's--can be prevented or delayed by long-term caloric restriction (consuming two-thirds the normal caloric intake).

Turner says the study also found that resveratrol was safe and well tolerated. The most common side effects experienced by participants were gastrointestinal-related, including nausea and diarrhea. Also, patients taking resveratrol experienced weight loss while those on placebo gained weight.

One outcome in particular was confounding, Turner notes. The researchers obtained brain MRI scans on participants before and after the study, and found that resveratrol-treated patients lost more brain volume than the placebo-treated group.

"We're not sure how to interpret this finding. A similar decrease in brain volume was found with some anti-amyloid immunotherapy trials," Turner adds. A working hypothesis is that the treatments may reduce inflammation (or brain swelling) found with Alzheimer's.

The study, funded by the National Institute on Aging and conducted with the Alzheimer's Disease Cooperative Study, began in 2012 and ended in 2014. GUMC was one of 21 participating medical centers across the U.S.

Further studies, including analysis of frozen blood and cerebrospinal fluid taken from patients, are underway to test possible drug mechanisms.

"Given safety and positive trends toward effectiveness in this phase 2 study, a larger phase 3 study is warranted to test whether resveratrol is effective for individuals with Alzheimer's -- or at risk for Alzheimer's," Turner says.

Resveratrol and similar compounds are being tested in many age-related disorders including cancer, diabetes and neurodegenerative disorders. The study Turner led, however, is the largest, longest and highest dose trial of resveratrol in humans to date.