Diet and supplements in cancer prevention

 

Cancer is a complex, multifactorial disease with a substantial global burden. Recent years have seen a surge in research focusing on preventive measures, particularly through diet and supplements. The role of nutrition in cancer incidence and prevention is widely recognized, though the specifics of these relationships remain under investigation. This review expands on the findings of Anandu Chandra Khanashyam et al., exploring the nuanced links between diet, supplements, and cancer prevention.

The significance of diet and supplements in cancer prevention is well-documented, with nutrition being a key factor in cancer incidence. Epidemiological research highlights the complex interactions between dietary factors and cancer risk, yet inconsistencies persist, limiting firm conclusions. Factors such as obesity, high-calorie foods, sugary beverages, and processed meats are known to increase cancer risk. Conversely, diets rich in whole grains, vegetables, and fruits are believed to reduce this risk. Obesity is linked to 14% of cancer deaths in men and 20% in women, with specific dietary factors like alcohol, red meats, and aflatoxins being associated with various cancers.

Evidence Linking Diet and Cancer

Historical and contemporary research underscores the role of diet in cancer development. The physician Galen in 168 BC first suggested diet's involvement in cancer growth. Modern epidemiological studies have consistently shown correlations between specific foods and cancer risk. Factors like the amount, timing, and duration of exposure to bioactive food components influence cellular responses and cancer development. It is now understood that the effects are likely due to multiple carcinogenic pathways acting in concert rather than individual compounds.

Dietary Patterns and Cancer Risk

Shifting from a nutrient-centric approach to examining overall dietary patterns offers a more comprehensive understanding of diet's impact on cancer risk. Healthy dietary patterns, characterized by high intake of fruits, vegetables, and whole grains, are associated with a lower risk of cancers, particularly colon and breast cancer. Processed and red meats, which contain carcinogenic compounds formed during high-temperature cooking, are linked to gastrointestinal cancers. However, the evidence remains complex and sometimes contradictory.

Dietary Supplements in Cancer Prevention

While certain micronutrients and antioxidants, such as vitamins B12, D, C, selenium, folic acid, and carotenoids, have shown potential in cancer prevention, their indiscriminate use can be harmful. Well-nourished individuals might not benefit from additional supplements, and excessive intake could increase cancer risk. Phytochemicals and plant extracts, like polyphenols found in fruits, vegetables, and beverages, are promising due to their anti-carcinogenic properties. These compounds can alter molecular processes of metastasis and suppress carcinogenesis initiation.

Phytochemicals and Plant Extracts

Polyphenols, a diverse group of plant constituents, play a significant role in cancer prevention. They are categorized into flavonoids, phenolic acids, lignans, stilbenes, and other polyphenols, with the majority found in fruits, vegetables, and nuts. These compounds exhibit protective effects against various cancers. Probiotics, another functional food group, modify gut microbiota, neutralize carcinogens, and enhance gut barrier function, thus reducing tumor growth and metastasis.

Conclusions

Lifestyle and dietary habits significantly influence cancer risk. Adopting a balanced diet rich in fruits, vegetables, whole grains, and legumes can lower cancer risk. Antioxidants in these foods help repair cells and reduce inflammation, counteracting cancer cell mechanisms. While epidemiological and clinical research has advanced our understanding of diet and cancer prevention, further studies are necessary to clarify these relationships. Caution is advised against excessive supplement use, and dietary modifications should be part of a holistic approach to cancer prevention. There is no conclusive evidence favoring a specific diet, but general healthy dietary patterns positively impact cancer prevention.

In summary, diet and dietary supplements hold promise in cancer prevention, but their role must be understood within the broader context of overall lifestyle and dietary patterns. Continued research is essential to establish effective dietary strategies for cancer prevention.

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https://www.xiahepublishing.com/2835-3315/CSP-2023-00001

Despite risk, many unsure of temperature to heat food to prevent illness

 – With bird flu virus detected in cow’s milk, U.S. health authorities have warned the public against potential sources of exposure, including drinking raw or unpasteurized milk, and have reiterated a general warning that consuming uncooked or undercooked poultry or beef products can make you sick.

Relatively few people say they drink raw milk. Only 3% of U.S. adults report having consumed raw milk in the past 12 months, while 4% were not sure whether they had, according to a new nationally representative Annenberg Public Policy Center health survey of nearly 1,500 empaneled U.S. adults conducted in July.*

But many more people say they do not use a thermometer to ensure that their food is heated to a temperature high enough to kill bacteria and viruses, including avian influenza A viruses like the H5N1 strain now found in U.S. cattle. And most are unsure what internal food temperatures kill bacteria and viruses, according to the survey.

Using a food thermometer

Only about 1 in 4 U.S. adults (27%) report using a thermometer either “often” or “all the time” to check whether the meat, poultry, or fish they consume has reached an internal temperature that makes the food safe to eat. A similar proportion (29%) say they “never” use a thermometer to check food temperatures while 20% say they do “rarely” and 20% “sometimes.”

“Using a food thermometer to determine that meat, poultry, fish, and eggs have been cooked to a safe internal temperature, one that kills bacteria such as E. coli and salmonella, is a way of protecting yourself from food poisoning,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania. “Every cook should have a food thermometer within ready reach in the kitchen or near the grill.”

The data come from the 20th wave of a nationally representative panel of 1,496 U.S. adults, conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. This wave of the Annenberg Science and Public Health (ASAPH) Knowledge survey was fielded July 11-18, 2024, and has a margin of sampling error (MOE) of ± 3.6 percentage points at the 95% confidence level. See the topline and methodology for details.

Most unsure of correct food temperatures to kill viruses such as bird flu

According to the Centers for Disease Control and Prevention (CDC), “While there is no evidence that anyone in the United States has gotten infected with avian influenza A viruses after eating properly handled and cooked poultry products, uncooked poultry and poultry products (like blood) could have been the source of a small number of avian influenza A virus infections in people in Southeast Asia.” The USDA reported in May as part of testing of 96 dairy cows that the virus had been detected in the meat of one “cull” cow but it did not enter the food chain and the USDA is confident that the meat supply is safe: “While we have multiple safeguards in place to protect consumers, we continue to recommend consumers properly handle raw meats and cook to a safe internal temperature.”

The APPC survey finds that most U.S. adults do not know the correct temperatures to heat food to in order to kill the H5N1 virus, or bird flu. Thinking about the virus, the survey respondents were asked to indicate which of the measures below “will kill the H5N1 virus,” and to select all that apply. Over half of those surveyed (51%) indicated “not sure” on this item and 4% incorrectly said “none will kill”:

• Heating poultry to at least 165 degrees Fahrenheit (CORRECT): Fewer than 4 in 10 (38%) selected this option as correct. According to the CDC, cooking poultry and eggs to an internal temperature of 165 degrees kills bacteria and viruses, including H5N1.
• Heating ground beef to at least 165 degrees Fahrenheit (CORRECT): This is true, but less than 1 in 3 people surveyed (29%) selected it. (In fact, the CDC recommends heating ground beef to at least 160 degrees.)
• Heating steak to a least 145 degrees (CORRECT): Just over 1 in 5 (21%) selected this as correct. According to the CDC, whole cuts of beef should be heated to 145 degrees then allowed to rest for three minutes.
• Freezing beef to a temperature of at least 20 degrees Fahrenheit (INCORRECT): Only 7% chose this thinking it is correct (it is not). Bird flu survives indefinitely while frozen and remains infectious, according to the Occupational Safety and Health Administration.
• Heating beef to at least 120 degrees (INCORRECT): Only 10% chose this, but it is not correct.

The bird flu outbreak

Unpasteurized or raw milk comes from animals including cows, sheep, and goats, and it has not been pasteurized to kill harmful germs. Unpasteurized dairy products are estimated to “cause 840 times more illnesses and 45 times more hospitalizations than pasteurized products.” The CDC says that consuming unpasteurized milk and products made from it “can expose people to germs such as Campylobacter, Cryptosporidium, E. coli, Listeria, Brucella, and Salmonella.”

In fact, 171 people were sickened and 22 hospitalized from September 2023 to March 2024 in a salmonella outbreak connected to unpasteurized milk from Raw Farm, in Fresno, Calif., according to the New York Times, which said this is the largest recorded outbreak in over two decades linked to raw milk.

In June, the FDA reported in an open letter that bird flu, or the H5N1 avian influenza virus, has been detected in cow’s milk. The presence of H5N1 bird flu was confirmed in cattle in the United States in mid-March 2024. As of July 25, 2024, there had been 13 human cases of bird flu in the United States since April 2024, four following exposure to cows and nine following exposure to poultry in Colorado. As of mid-July, 168 cattle herds in 13 states – and over 100 million poultry in 48 states – were affected.

Raw milk and bird flu

As of mid-June 2024, the FDA concluded “that the totality of evidence continues to indicate that the commercial milk supply [which is pasteurized] is safe.” The FDA says it does not currently know whether the H5N1 virus can be transmitted to humans through consumption of raw milk products from infected cows, though a study with mice concluded that the virus in “untreated milk can infect susceptible animals that consume it” and the National Institutes of Health (NIH) says this suggests that drinking raw milk “may pose a risk of transmission to people.”

The Annenberg survey finds that 15% of respondents think drinking raw milk increases the chances of getting bird flu, while 33% think it has no effect one way or the other on the chances of getting bird flu. Nearly half of those surveyed (49%) are not sure.

What people know of pasteurization and the risks of raw milk

According to the CDC, pasteurization “is crucial for milk safety, killing harmful germs that can cause illness” and the NIH says “dairy milk purchased in the grocery store has been pasteurized – heated to a level high enough and long enough to kill most viruses or bacteria in the milk.”

Yet the current survey shows just over half of those surveyed (54%) know that unpasteurized milk is less safe to drink than pasteurized milk. While 6% say raw milk is safer to drink and 13% say it is just as safe, 27% say they are not sure which is safer.

The survey also finds that:

• Bacteria and viruses: 62% think it is likely that raw milk contains bacteria and viruses that can make you sick, while 16% say it is unlikely and 22% are not sure.
• Effectiveness of pasteurization: 77% know pasteurization is effective at killing bacteria and viruses in raw milk, while 4% say it is not effective and 20% are not sure.
• Nutrients: Over a quarter of those surveyed (26%) say raw milk has more nutrients than pasteurized milk, 30% think it has “about the same amount of nutrients as pasteurized milk,” and 40% are not sure.

While those who advocate for drinking raw milk contend that pasteurization destroys valuable nutrients, the FDA says that raw milk “is not nutritionally superior” to pasteurized milk.

Bird flu and the seasonal flu vaccine

Nearly two-thirds of those surveyed do not know that the seasonal flu vaccine will not help prevent bird flu – 21% think it does help a person who is exposed to the H5N1 bird flu from developing severe illness and 44% are not sure whether it does. Just over a third of those surveyed (35%) know that the seasonal flu vaccine does not help someone exposed to bird flu from developing severe illness.

APPC’s ASAPH survey

The survey data come from the 20th wave of a nationally representative panel of 1,496 U.S. adults, first empaneled in April 2021, conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. This wave of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded July 11-18, 2024, and has a margin of sampling error (MOE) of ± 3.6 percentage points at the 95% confidence level. All figures are rounded to the nearest whole number and may not add to 100%. Combined subcategories may not add to totals in the topline and text due to rounding.

See the topline and methodology for additional details.

The policy center has been tracking the American public’s knowledge, beliefs, and behaviors regarding vaccination, Covid-19, flu, maternal health, climate change, and other consequential health issues through this Annenberg Science and Public Health (ASAPH) survey panel for over three years. In addition to Jamieson, the APPC team includes senior data analyst Laura Gibson; research analyst Shawn Patterson Jr.; Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute, who developed the questions; and Ken Winneg, managing director of survey research.

The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about communication’s role in advancing public understanding of political, science, and health issues at the local, state, and federal levels.

* The percentage of raw milk drinkers found in the APPC survey, which included non-milk drinkers, is roughly consistent with a Food and Drug Administration (FDA) 2016 food safety report finding that 4% of U.S. adults who drink milk reported having had raw milk over the prior 12 months. Unlike the FDA survey, the APPC survey gave people the explicit option of indicating that they were not sure.

Everyday activities aren’t enough to protect against stroke

 

Research conducted at the University of Gothenburg shows that the physical activities we do as we go about our lives, at work or in the home, aren’t enough to protect us from having a stroke. However, exercising in our free time and using active modes of transport are associated with a decreased risk of stroke.

“Physical activity during leisure time and as transportation is becoming increasingly important now that many jobs and domestic activities are becoming more sedentary,” says lead author of the study Adam Viktorisson, researcher at Sahlgrenska Academy at the University of Gothenburg, Sweden.

Twenty years follow-up

The research study covers 3,614 people from the region of Västra Götaland, 269 of whom suffered a stroke in the twenty years spanned by the study. Three months after the stroke, 120 of these had died or were dependent on help to carry out activities of daily living.

Physical activity data was gathered from surveys. Some participants were also given a pedometer to wear. Physical activity during leisure time or for transportation showed a link to the objective measurements from the pedometers, while physical activity at work did not.

Occupational physical activity did not protect

The health benefits of physical activity are well known, but earlier studies tend to mainly focus on physical activity during leisure time. Research in recent years has shown that physical activity at work can instead have negative health impacts, increasing the risk of cardiovascular disease.

“How and when we carry out physical activity seems to play a crucial role in determining its health benefits. In our study leisure time and transport related physical activities were associated with a lower risk of stroke, whereas activities during work time or in the household were not” Adam Viktorisson points out.

“Physically demanding jobs are often linked to stress, little opportunity for recovery, air pollution and generally poorer socioeconomic conditions, which can counteract the positive effects of physical activity.”

Promote public health

The study used data from the INTERGENE cohort at the University of Gothenburg. Study participants were surveyed and data was collected from 2001 to 2004, encompassing both clinical data and questionnaire data. The researchers hope that these results will bring greater awareness and lead to changes in public health policy to encourage physical activity in society.“Encouraging people to be physically active in their daily lives, for example by walking, cycling and doing other types of exercise, can be an important strategy in reducing the number of strokes and improving the prognosis of people who suffer a stroke,” says Adam Viktorisson.

Healthy diet with less sugar is linked to younger biological age

Researchers at UC San Francisco have found a link between following a diet that is rich in vitamins and minerals, especially one without much added sugar, and having a younger biological age at the cellular level.  
 
They looked at how three different measures of healthy eating affected an “epigenetic clock” – a biochemical test that can approximate both health and lifespan – and found that the better people ate, the younger their cells looked. Even when people ate healthy diets, each gram of added sugar they consumed was associated with an increase in their epigenetic age. 
 
“The diets we examined align with existing recommendations for preventing disease and promoting health, and they highlight the potency of antioxidant and anti-inflammatory nutrients in particular,” said Dorothy Chiu, PhD, a postdoctoral scholar at the UCSF Osher Center for Integrative Health and first author of the study, which appears July 29 in JAMA Network Open. “From a lifestyle medicine standpoint, it is empowering to see how heeding these recommendations may promote a younger cellular age relative to chronological age.” 
 
The study is one of the first to show a link between added sugar and epigenetic aging, and the first to examine this link in a heterogenous group of women – both Black and white – in midlife. Most studies on the topic have involved older white participants.   
 
The study helps deepen our understanding of why sugar is so detrimental to health, added study co-senior author Elissa Epel, PhD, a UCSF professor in the Department of Psychiatry and Behavioral Sciences. 
 
“We knew that high levels of added sugars are linked to worsened metabolic health and early disease, possibly more than any other dietary factor,” Epel said. “Now we know that accelerated epigenetic aging is underlying this relationship, and this is likely one of many ways that excessive sugar intake limits healthy longevity.” 
 
Women in the study reported consuming an average of 61.5 grams of added sugar per day, though the range was large: from 2.7 to 316 grams of added sugar daily. A bar of milk chocolate has about 25 grams of added sugar, while a 12-ounce can of cola has about 39 grams. The U.S. Food and Drug Administration recommends adults consume no more than 50 grams of added sugar per day. 
 
 A nutrient-based approach 
 
For the cross-sectional study, researchers analyzed food records from 342 Black and white women with a mean age of 39 years from Northern California. Then, they compared their diets with epigenetic clock measures, which were derived from saliva samples.  
 
Researchers scored the women’s diets to see how they compared to a Mediterranean-style diet rich in anti-inflammatory and antioxidant foods and then to a diet linked to lower risk for chronic disease.  
 
Finally, they scored the women’s diets against a measure they created called the “Epigenetic Nutrient Index (ENI)”, which is based on nutrients (not foods) that have been linked to anti-oxidative or anti-inflammatory processes and DNA maintenance and repair. These include Vitamins A, C, B12 and E, folate, selenium, magnesium, dietary fiber and isoflavones.  
 
Adherence to any of the diets was significantly associated with lower epigenetic age, with the Mediterranean diet having the strongest association.  
  
The researchers examined sugar intake separately and found that consuming foods with added sugar was associated with accelerated biological aging, even in the presence of an otherwise healthy diet.  
 

“Given that epigenetic patterns appear to be reversible, it may be that eliminating 10 grams of added sugar per day is akin to turning back the biological clock by 2.4 months, if sustained over time,” said co-senior author Barbara Laraia, PhD, RD, a UC Berkeley professor in the Food, Nutrition and Population Health program. “Focusing on foods that are high in key nutrients and low in added sugars may be a new way to help motivate people to eat well for longevity.”   

Moderate drinking won’t lengthen your life

 

 – Probably everyone has heard the conventional wisdom that a glass of wine a day is good for you--or you’ve heard some variation of it. The problem is that it’s based on flawed scientific research, according to a new report in the Journal of Studies on Alcohol and Drugs.

Over the years, many studies have suggested that moderate drinkers enjoy longer lives with lower risks of heart disease and other chronic ills than abstainers do. That spurred the widespread belief that alcohol, in moderation, can be a health tonic. However, not all studies have painted such a rosy picture--and the new analysis sheds light on why.

In a nutshell, studies linking moderate drinking to health benefits suffer from fundamental design flaws, said lead researcher Tim Stockwell, Ph.D., a scientist with the Canadian Institute for Substance Use Research at the University of Victoria.

The major issue: Those studies have generally focused on older adults and failed to account for people’s lifetime drinking habits. So moderate drinkers were compared with “abstainer” and “occasional drinker” groups that included some older adults who had quit or cut down on drinking because they’d developed any number of health conditions.

“That makes people who continue to drink look much healthier by comparison,” Stockwell said.

And in this case, he noted, looks are deceiving.

For the analysis, Stockwell and his colleagues identified 107 published studies that followed people over time and looked at the relationship between drinking habits and longevity. When the researchers combined all the data, it looked like light to moderate drinkers (that is, those who drank between one drink per week and two per day) had a 14% lower risk of dying during the study period compared with abstainers.

Things changed, however, when the investigators did a deeper dive. There were a handful of “higher quality” studies that included people who were relatively young at the outset (younger than 55, on average) and that made sure former and occasional drinkers were not considered “abstainers.” In those studies, moderate drinking was not linked to a longer life.

Instead, it was the “lower quality” studies (older participants, no distinction between former drinkers and lifelong abstainers) that did link moderate drinking to greater longevity.

“If you look at the weakest studies,” Stockwell said, “that’s where you see health benefits.”

The notion that moderate drinking leads to a longer, healthier life goes back decades. As an example, Stockwell pointed to the “French paradox”--the idea, popularized in the 1990s, that red wine helps explain why the French enjoy relatively low rates of heart disease, despite a rich, fatty diet. That view of alcohol as an elixir still seems to be “ingrained” in the public imagination, Stockwell noted.

In reality, he said, moderate drinking likely does not extend people’s lives--and, in fact, carries some potential health hazards, including increased risks of certain cancers. That’s why no major health organization has ever established a risk-free level of alcohol consumption.

“There is simply no completely ‘safe’ level of drinking,” Stockwell said.

Greater pulse consumption in American children is associated with a higher diet quality

 

 

IMAGE: 

WHEN PEOPLE ADD ONE CUP OF BEANS AND/OR CHICKPEAS DAILY TO THEIR DIET, DIET QUALITY IMPROVES.

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CREDIT: THE COALITION FOR THE ADVANCEMENT OF PULSES

    New research showing the association between greater pulse consumption and significant health related outcomes in American children will be presented during the Society for Nutrition Education and Behavior’s (SNEB) International Conference 2024 in Knoxville, TN. The poster session is scheduled for Tuesday, July 30, 2024, from 4:30 -5:30 PM ET at University of Tennessee, Knoxville, Student Union.  SNEB, an international organization of professionals actively involved in nutrition education and health promotion, has a vision of healthy communities, food systems, and behaviors.

Using data from the National Health and Nutrition Examination Survey, 2001-2018, researchers aimed to identify commonly consumed pulse (beans, peas, and lentils) dietary patterns in American children and assess shortfall nutrient intakes and diet quality relative to children whose typical dietary pattern avoids pulses.  Results show that greater consumption of pulses is associated with significant greater shortfall nutrient intake relative to the no-pulse dietary pattern.  According to the findings, a dietary pattern comprised of approximately 2 servings of pulses daily is associated with significantly higher total diet quality scores compared to the no pulse dietary pattern.  Children consuming approximately 2 servings of pulses daily have significantly higher dietary fiber, potassium, and choline intake relative to non-consumers of beans.   

“We know that the majority of children are not meeting established recommendations for fruits, vegetables or pulses,” states study author Yanni Papanikolaou, of Nutritional Strategies Inc.  “Pulses are excellent sources of fiber, folate and potassium and excellent sources of plant protein that also provides iron and zinc like other protein foods.” The study was funded by Cannedbeans.org on behalf of Bush’s Best and the Coalition for the Advancement of Pulses.

Pulses remain under consumed in the United States, with greater than 80% of the population below recommendations.[i] Research shows that pulses help meet micro-nutrient demands in childhood and should be part of children’s diets once solid foods are introduced.[ii]  Dietary patterns rich in beans and pulses (including kidney beans, black beans, pinto beans and/or chickpeas) are associated with significantly higher diet quality scores. Highest diet quality scores are associated with 24% decreased risk of cardiovascular disease, 31% reduced risk for coronary heart disease, 20% lowered risk for stroke, 23% decreased risk for diabetes, and 6% reduced risk for cancer. [iii] 

“This research supports the growing body of evidence that consumption of pulses may have numerous nutrient and public health benefits,” said Tim McGreevy, CEO, of USA Pulses.  “The Dietary Guidelines for Americans 2020 – 2025 and the USDA’s Choose My Plate indicate that beans, chickpeas, peas, and lentils can be considered as part of the vegetable or protein groups.”

Older adults want to cut back on medication, but study shows need for caution

 

More than 82% of Americans age 50 to 80 take one or more kinds of prescription medication, and 80% of them say they’d be open to stopping one or more of those drugs if their health care provider gave the green light, a new University of Michigan study shows.

But it’s not as simple as that, the researchers say. They call for prescribers and pharmacists to talk with older adults about their personal situation and figure out if any kind of “deprescribing” is right for them.

The study, published in the Journal of General Internal Medicine, uses data from U-M’s National Poll on Healthy Aging, and builds on a poll report issued in April 2023.  

It shows that about 30% of older adults who take medication to address cardiovascular disease or diabetes are most interested in deprescribing these medications. This might be because many of those drugs address symptomless risk factors such as high blood pressure, high cholesterol and high blood sugar.

Left uncontrolled, these risk factors can set the stage for future emergencies and crises. So medications to manage these conditions are important preventive tools.

However, older adults may not immediately feel the benefit of these medications, which may cause them to wonder if they continue to be needed.

In contrast, the study shows that older adults whose prescriptions address conditions that cause symptoms right now — including arthritis pain, mental health conditions and breathing issues —were less interested in stopping those medications.

The new study underscores the importance of comprehensive medication reviews, says Sarah Vordenberg, Pharm.D., M.P.H., the study’s lead author and a clinical associate professor in the U-M College of Pharmacy.

These appointments look at all the medicines and supplements a person is taking, and look for opportunities to safely reduce dosages, costs and the number of times each day a person must take medication.

Medicare pays for such appointments for enrollees who meet eligibility requirements. But the number of older adults taking advantage of this option, even among those who qualify, as evidenced by data from a 2020 report by the National Poll on Healthy Aging.

Condition-specific preferences

The new study goes beyond the 2023 deprescribing poll report by delving into the conditions the poll respondents said they had.

• 84% of people taking at least one prescription medication said they had some form of cardiovascular condition, which included high blood pressure, and 35% of this group were open to stopping at least one of their cardiovascular medications.
• 29% of respondents taking at least one medication said they had diabetes, and 30% of this group were open to stopping one of their diabetes medications.
• Nearly 50% of the respondents taking prescription medication said they have arthritis, but only 17% of this group were open to stopping a medication for that condition.
• 22% of those taking prescription medication said they had a brain-related condition affecting their mental health or cognition, and 19% of them were open to stopping a medication they take for it.
• 11% of prescription drug users said they had a lung disease such as asthma or chronic obstructive pulmonary disease. Of them, 11% said they would be open to stopping a drug they take for it.

“With guidelines changing for the use of cardiovascular risk-reducing medications as we learn more about who gets the most benefit, it’s important that patients and providers talk openly and regularly about what’s best for their individual circumstances,” says Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System.

“The same goes for diabetes-related medication, especially with the rise of direct-to-consumer services including for GLP-1 inhibitor medications,” he added. “And with any prescription medication or supplement for any condition, it’s critical for your health care providers to know everything you’re taking, no matter how you’re getting it.”

For more about the poll, which is based at the U-M Institute for Healthcare Policy and Innovation and funded by AARP and Michigan Medicine, U-M’s academic medical center, visit https://www.healthyagingpoll.org/

For more about other deprescribing research by Vordenberg and colleagues, visit https://ihpi.umich.edu/news/why-patients-say-they-want-take-fewer-prescription-meds-wont-when-offered-0

Boosting fruit intake during midlife can ward off late-life blues

 

In a large Singapore cohort study involving over 13,000 participants spanning close to 20 years, higher consumption of fruits during midlife was found to be associated with lower odds of depressive symptoms at late-life

Populations are rapidly ageing worldwide, and there is an increased prevalence of late-life depressive symptoms among older adults, which include depressed feelings, lack of pleasure, delayed cognitive processing and reduced volitional activity, often accompanied by loss of appetite, insomnia, poor concentration, and increased fatigue. This has been related to underlying neurodegenerative changes in the brain associated with ageing. The growing imperative to keep older adults in good health has spurred extensive research into approaches that could prevent late-life depression, and accumulating evidence has revealed the plausible role of dietary factors in protecting against depression in ageing. Could specific diet or food items consumed earlier in life have an impact on mental well-being in later years?

In a longitudinal study conducted by the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), involving 13,738 participants from the large population-based Singapore Chinese Health Study that tracked participants through their mid-life to later life spanning about 20 years, researchers found that participants who consumed higher quantities of fruits earlier in life exhibited a reduced likelihood of experiencing depressive symptoms later in life.

 

The authors studied a total of 14 fruits most commonly consumed in Singapore and found that the consumption of most fruits, including oranges, tangerines, bananas, papayas, watermelons, apple and honey melon, was associated with reduced likelihood of depression. The association could possibly be the high levels of antioxidants and anti-inflammatory micronutrients in fruits—such as vitamin C, carotenoids and flavonoids—which have been shown to reduce oxidative stress and inhibit inflammatory processes in the body that may affect the development of depression. Consumption of vegetables, on the other hand, was found to have no association with the likelihood of depressive symptoms. The findings, published in the Journal of Nutrition, Health and Aging, provide valuable insights into the potential benefits of eating sufficient fruits in mitigating depressive symptoms later in life.

 

Professor Koh Woon Puay from the Healthy Longevity Translational Research Programme at NUS Medicine and Principal Investigator of the study, said, “Our study underscores the importance of fruit consumption as a preventive measure against ageing-related depression. In our study population, participants who had at least 3 servings of fruits a day, compared to those with less than one serving a day, were able to reduce the likelihood of ageing-related depression significantly by at least 21%. This can be achieved by eating one to two servings of fruits after every meal. We did not see any difference in our results between fruits with high and low glycemic index. Hence, for those with diabetes, they can choose fruits with low glycemic index that will not raise blood sugars as much as those with high index.”

 

At the initial stage of the study from 1993 to 1998, when participants were of average age of 51 years, they were asked to answer a structured questionnaire on how often they consumed a standard serving size of each food item daily, for 14 fruits and 25 vegetables. In 2014 to 2016, when participants were of average age of 73 years, depressive symptoms were examined using a standard test (Geriatric Depression Scale) and 3,180 (23.1%) participants who reported having five or more symptoms were considered to have depression in our study. After adjusting for factors that could potentially confound the relationship, including medical history, smoking status, level of physical activity, sleep duration, and ageing-related factors, the team found that higher consumption of fruits, but not vegetables, was associated with lower odds of depressive symptoms in a stepwise manner.

 

Prof Koh added, “Our study aimed to examine the relationship of mid-life consumption of fruits and vegetables with the risk of depressive symptoms in late life. Although other studies have also examined the associations of fruits and vegetables with risk of depression, there are inconsistencies in the results, and many of them were done in Western populations. To our best knowledge, ours is the largest population-based study in an Asian population to study this association.”

 

These findings suggest that promoting fruit consumption for individuals in mid adulthood, typically defined as ages 40 to 65 years, could yield long-term benefits for their mental well-being at late adulthood beyond 65 years. Hence, the study’s results hold significant implications for public health education and initiatives to make fruits more accessible for the general population. Following the study, the research team is looking into the association of other modifiable behavioural factors, such as sleep duration, smoking and other dietary factors, with the mental health of older adults.

Quit Googling and take naps to cut dementia risk

 

People can reduce their risk of age-related dementia by exercising their brains properly instead of Googling, according to a leading Canadian academic.

Professor Mohamed I. Elmasry says simple daily habits such as afternoon naps, memory ‘workouts’ and not reaching for a smartphone can increase the odds of healthy aging.

His new book, iMind: Artificial and Real Intelligence (with foreword by Canadian cell biologist Dr. Aileen Burford-Mason), says the focus has shifted too far away from RI (natural, or real) intelligence in favor of AI (machine, or artificial) intelligence. Elmasry instead calls us to nurture our human mind which, like smartphones, has ‘hardware’, ‘software’ and ‘apps’ but is many times more powerful – and will last much longer with the right care.

Professor Elmasry, an internationally recognized expert in microchip design and AI, was inspired to write the book after the death of his brother-in-law from Alzheimer’s and others very close to him, including his mother, from other forms of dementia.

Although he says that smart devices are ‘getting smarter all the time’, he argues in iMind that none comes close to ‘duplicating the capacity, storage, longevity, energy efficiency, or self-healing capabilities of the original human brain-mind’.

He writes that: “The useful life expectancy for current smartphones is around 10 years, while a healthy brain-mind inside a healthy human body can live for 100 years or longer.

“Your brain-mind is the highest-value asset you have, or will ever have. Increase its potential and longevity by caring for it early in life, keeping it and your body healthy so it can continue to develop.

“Humans can intentionally develop and test their memories by playing ‘brain games,’ or performing daily brain exercises. You can’t exercise your smartphone’s memory to make it last longer or encourage it to perform at a higher level.”

In iMind: Artificial and Real Intelligence Professor Elmasry shares an anecdote about his grandchildren having to use the search engine on their smartphones to name Cuba’s capital—they had just spent a week in the country with their parents.

The story illustrates how young people have come to rely on AI smartphone apps instead of using their real intelligence (RI), he says, adding: “A healthy memory goes hand-in-hand with real intelligence. Our memory simply can’t reach its full potential without RI.”

Published by Routledge, iMind: Artificial and Real Intelligence includes extensive background on the history of microchip design, machine learning and AI and their role in smartphones and other technology.

The book also explains how both AI and human intelligence really work, and how brain function links the mind and memory. It compares the human mind and brain function with that of smartphones, ChatGPT and other AI-based systems.

Drawing on comprehensive existing research, iMind aims to narrow the knowledge gap between real and artificial intelligence, to address the current controversy around AI, and to inspire researchers to find new treatments for Alzheimer’s, other neurodegenerative conditions and cancer.

It argues that current or even planned AI cannot match the capabilities of the human brain-mind for speed, accuracy, storage capacity and other functions. Healthy aging, Professor Elmasry notes, is as important as climate change but doesn’t attract a fraction of the publicity.

He calls for policymakers to adopt a series of key reforms to promote healthy aging. Among such changes, he suggests that bingo halls could transition from their sedentary entertainment function to become active and stimulating learning centers.

As well as napping to refresh our memories and other brain and body functions, he also outlines a series of practical tips to boost brain power and enhance our RI (Real Intelligence).

These include building up ‘associative’ memory – the brain’s ‘dictionary of meaning’ where it attaches new information to what it already knows. Try reading a book aloud, using all of your senses instead of going on autopilot and turning daily encounters into fully-lived experiences.

Other techniques include integrating a day for true rest into the week, reviewing your lifestyle as early as your 20s or 30s, adopting a healthy diet, and eliminating or radically moderating alcohol consumption to reduce the risk of dementia.

When you eat may impact your overall health

 

 Accumulating evidence on the effect of the time of eating in relation to our circadian rhythm and metabolism shows that when we eat may influence our overall health and well-being. A special issue of the Journal of the Academy of Nutrition and Dietetics (JAND) on chrononutrition, published by Elsevier, examines the effects of various fasting regimens and covers safety considerations and practical guidance.

The field of chrononutrition is gaining traction as it explores the relationship between temporal eating patterns, circadian rhythms, and metabolism for optimal health.

Guest Editor Krista Varady, PhD, Department of Kinesiology and Nutrition, University of Illinois Chicago, specializes in studying the efficacy of intermittent fasting for weight loss, weight management, and lowering the risk of metabolic diseases in obese adults. With more than 15 years of research experience, she is recognized as one of the top researchers in this field.

Dr. Varady says, "Intermittent fasting has emerged as one of the most popular diets for weight loss in recent years. The diet can be defined, in basic terms, as periods of eating, alternated with periods of not eating. This special issue examines the effects of various fasting regimens, such as time-restricted eating, alternate day fasting, and the 5:2 diet, on body weight, cardiometabolic disease risk, and sleep and exercise performance in human subjects. Pertinent safety considerations and practical guidance on applying the diets are also covered."

Editor-in-Chief of JAND, Linda G. Snetselaar, PhD, RDN, FAND, LD, a professor in the Department of Epidemiology at the University of Iowa, adds, "The findings presented in this special issue have important clinical implications. I believe the timing of eating will become increasingly important as we address dietary interventions related to chronic disease risk factors."

The special issue includes the novel study "Randomized Controlled Feasibility Trial of Late 8-Hour Time-Restricted Eating for Adolescents With Type 2 Diabetes," in which researchers examine the feasibility of eating within an 8-hour window as an interventional strategy for weight loss and glucose management among adolescents diagnosed with obesity and new-onset type 2 diabetes, compared with a prolonged eating window.

Lead investigator Alaina P. Vidmar, MD, Children’s Hospital Los Angeles and Keck School of Medicine of USC, explains, "The prevalence of type 2 diabetes in adolescents is steadily increasing, specifically among historically marginalized communities. Many adolescents prefer to go to bed later and sleep in later, so an early eating window may not align with developmental and social schedules that often shift their food consumption to later in the day. We trialed a late eating window for our cohort and found that late time-restricted eating is safe and acceptable for this subset of adolescents as it can result in clinically meaningful weight loss, reduction in alanine transaminase, and significant caloric reduction; it did not negatively impact sleep, eating behaviors, or physical activity."

Another paper, "Indices of Sleep Health Are Associated With Timing and Duration of Eating in Young Adults," details findings from a cross-sectional study among 52 young adults without chronic diseases or conditions on whether timing and/or duration of eating behaviors throughout the day affect sleep health.

Lead investigator Jess A. Gwin, PhD, Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, says, "Breakfast skipping and nighttime eating are among typical eating behaviors observed in young adults in the United States. Our study found that the timing of eating was associated with sleep-wake onset and sleep efficiency. This highlights the need for additional studies to understand whether manipulating the timing of eating occasions to better align with sleep-wake cycles could improve sleep health."

Interventions tailored to individuals’ preferences and circumstances may benefit time-restricted eating adherence, according to the article "Time-Restricted Eating in Community-Dwelling Adults: Correlates of Adherence and Discontinuation in a Cross-Sectional Online Survey Study.” Leader of the research team Sydney G. O’Connor, PhD, Office of Behavioral and Social Sciences Research, National Institutes of Health, notes, "Dietary adherence is the strongest predictor of successful weight loss and maintenance; therefore, identifying dietary strategies that facilitate adherence is a priority in the field of behavioral weight management. We looked at motivators such as weight maintenance, health (not weight), improved sleep, disease prevention, and drivers such as the ability to work from home and the impact of COVID-19."

Dr. Varady concludes, "Many people stop adhering to standard diets that restrict calories because they become frustrated with having to regularly monitor food intake day in and day out. Intermittent fasting protocols can bypass this requirement by allowing participants to simply ‘watch the clock’ instead of monitoring calories, while still producing weight loss. Furthermore, intermittent fasting does not require the purchase of expensive food products and allows individuals to continue consuming familiar foods, making it a highly accessible diet, especially for lower resource patient groups. Although fasting regimens are no more effective than other diet interventions for weight management, these protocols offer individuals an alternative, straightforward approach to addressing obesity by omitting the need for calorie counting. While weight loss is important, having a diet with a wide variety of nutrient dense foods such as fruits, vegetables and legumes is paramount in maintaining a replete nutritional status. These foods can be both inexpensive and culturally appropriate."

Working toward alternative diets to manage IBS

Two studies from Michigan Medicine may provide hope for patients with irritable bowel syndrome struggling to implement the traditional low-FODMAP diet.

The resulting papers— “FODMAPs aren’t created equal: Results of a randomized reintroduction trial in patients with irritable bowel syndrome” and “Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results from a Double-Blind, Pilot Randomized Controlled”—both appeared in Clinical Gastroenterology and Hepatology.

In the low-FODMAP diet, patients with IBS restrict their intake of certain carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), before gradually reintroducing each to determine sensitivity. 

However, since this diet restricts such a wide range of foods (e.g. garlic, certain fruits, gluten-based bread), many individuals suffering from IBS find it hard to implement and even harder to stick with. 

“It’s frustrating for us as clinicians to say, ‘Here, just cut out all these things, and you'll be fine’,” said Shanti Eswaran, M.D., lead author of the first paper. 

“No one wants to live like that. So, we looked at whether or not we really need to take out everything that's in the diet. Or if, for some people, they can get away with a modified version of this restriction plan.”

In the first study, participants started on the traditional low-FODMAP restriction diet, but then had different FODMAP foods reintroduced blindly. 

The researchers found that patients reacted to an average of two FODMAPs.

The data also suggested that individual FODMAPs alone could cause symptoms—as opposed to all the FODMAPs at once.

The most significant, finding however, was that fructans and galacto-oligosaccharides (GOS) were the most likely to worsen symptoms such as abdominal pain and bloating. 

Fructans are commonly found in onions, garlic, and wheat. Foods containing GOS include legumes and cruciferous vegetables.

“That led to the second study, in which an alternative ‘FODMAP-simple’ diet was developed and implemented,” said William Chey, M.D., chief of the Division of Gastroenterology and Hepatology at Michigan, and an author on both studies. 

FODMAP-simple restricts only fructans and GOS without restricting other FODMAP groups (polyols, lactose, and fructose), while traditional low FODMAP restricts all five FODMAP groups. 

At the end of that study, FODMAP-simple led to similar reductions as low-FODMAP to key symptoms of IBS.

There are several benefits to simplifying the traditional low-FODMAP approach. 

Many patients find the diet hard to start, depending on their existing habits and available food. 

The restriction period of the process can also lead to weight loss and deficiencies in certain nutrients, such as iron and calcium.

“Cost becomes an issue, because the more exclusion you have to do, the more substitutes you'd have to purchase,” said Prashant Singh, MBBS, lead author of the second paper. 

“Let’s say you are somebody who eats green beans, beans, and chickpeas, and now you must substitute all of that. Or you're substituting in gluten-free bread or lactose-free milk, which is more expensive than lactose-containing milk. All of those costs add up very quickly.”

While the doctors involved agree more research is necessary before recommending a diet like FODMAP-simple to patients, they are encouraged that these early results could herald changes that will one day improve the lives of patients with IBS.

Irregular sleep patterns lead to increased risk of type 2 diabetes

 

Getting consistent sleep could help stave off type 2 diabetes, new research suggests. A study led by investigators at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, analyzed sleep patterns over the course of 7 nights and then followed participants for more than seven years. The researchers discovered that irregular sleep durations were associated with increased risk of diabetes, with individuals with the greatest irregular patterns have a 34 percent higher diabetes risk than their counterparts. The findings, published in Diabetes Care, suggest the importance of regular sleep for diabetes prevention.

“Our study identified a modifiable lifestyle factor that can help lower the risk of developing type 2 diabetes,” said lead author Sina Kianersi, PhD, a research fellow in the Channing Division of Network Medicine at Brigham and Women's Hospital. “Our findings underscore the importance of consistent sleep patterns as a strategy to reduce type 2 diabetes."

Type 2 diabetes affects close to half a billion people worldwide and is one of the top 10 leading causes of death and disability. The number of people with type 2 diabetes is expected to more than double to 1.3 billion by 2050. This dire situation highlights the need for innovative strategies for diabetes prevention.

The new study analyzed accelerometry data from more than 84,000 participants in the UK Biobank Study to investigate any possible association between sleep and type 2 diabetes. Participants were an average age of 62 years (57% female, 97% white) and were initially free of diabetes. They wore accelerometers—devices like watches that monitor movement—for seven nights. The participants were followed for approximately 7.5 years, tracking diabetes development mostly through medical records.

The study set out to investigate two key questions. First, to discover whether irregular sleep durations may promote diabetes development through circadian disruption and sleep disturbances. Second, to explore whether this association varies across genetic predispositions to diabetes.

The investigators found that more irregular sleep duration was associated with higher diabetes risk after adjusting for a wide range of risk factors. This association was more pronounced in individuals with longer sleep duration and lower polygenic risk score for diabetes.

The data revealed that compared to participants with regular sleep patterns, those with irregular sleep (where day-to-day sleep duration varied by more than 60 minutes on average) had a 34% higher risk of developing diabetes. The risk decreased, yet persisted, even after accounting for lifestyle, co-morbidities, family history of diabetes, and obesity indicators.

There were some study limitations. Certain lifestyle information used in the research was collected up to five years before the accelerometer study began. This might have affected the accuracy of the results. Also, the assessment of sleep duration based on 7-days may not capture long-term sleep patterns. Lastly, study participants were mainly healthy, older, and white, and may not represent outcomes for more diverse populations.

The researchers plan to study participants from younger age groups and with diverse racial backgrounds. They are also interested in exploring the biological reasons for why sleep irregularity increases the risk of diabetes.

“Our findings have the potential to improve diabetes prevention on multiple levels,” said Kianersi. “Clinically, they might inform better patient care and treatment plans. Public health guidelines could promote regular sleep patterns. However, more research is needed to fully understand the mechanism and confirm the results in other populations."